Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study

Background. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding a...

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Main Authors: Hao Wang, Richard D. Robinson, John S. Garrett, Kellie Bunch, Charles A. Huggins, Katherine Watson, Joni Daniels, Brett Banks, James P. D’Etienne, Nestor R. Zenarosa
Format: Article
Language:English
Published: Wiley 2015-01-01
Series:Emergency Medicine International
Online Access:http://dx.doi.org/10.1155/2015/401757
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author Hao Wang
Richard D. Robinson
John S. Garrett
Kellie Bunch
Charles A. Huggins
Katherine Watson
Joni Daniels
Brett Banks
James P. D’Etienne
Nestor R. Zenarosa
author_facet Hao Wang
Richard D. Robinson
John S. Garrett
Kellie Bunch
Charles A. Huggins
Katherine Watson
Joni Daniels
Brett Banks
James P. D’Etienne
Nestor R. Zenarosa
author_sort Hao Wang
collection DOAJ
description Background. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool) was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS) patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery.
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spelling doaj-art-2797125a93034722b3fbb9b15a78aa4c2025-02-03T06:12:20ZengWileyEmergency Medicine International2090-28402090-28592015-01-01201510.1155/2015/401757401757Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation StudyHao Wang0Richard D. Robinson1John S. Garrett2Kellie Bunch3Charles A. Huggins4Katherine Watson5Joni Daniels6Brett Banks7James P. D’Etienne8Nestor R. Zenarosa9Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USADepartment of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USADepartment of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USADepartment of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USADepartment of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USADepartment of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USADepartment of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USADepartment of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USADepartment of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USADepartment of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USABackground. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool) was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS) patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery.http://dx.doi.org/10.1155/2015/401757
spellingShingle Hao Wang
Richard D. Robinson
John S. Garrett
Kellie Bunch
Charles A. Huggins
Katherine Watson
Joni Daniels
Brett Banks
James P. D’Etienne
Nestor R. Zenarosa
Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study
Emergency Medicine International
title Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study
title_full Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study
title_fullStr Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study
title_full_unstemmed Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study
title_short Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study
title_sort use of the sonet score to evaluate high volume emergency department overcrowding a prospective derivation and validation study
url http://dx.doi.org/10.1155/2015/401757
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