Original Article

An Overcrowding Measurement Study in the Adult Emergency Department of Gazi University Hospital, Using the “National Emergency Departments Overcrowding Study” (Nedocs) Scale


  • Mehmet Ergin
  • Ahmet Demircan
  • Ayfer Keleş
  • Fikret Bildik
  • Evin Aras
  • Işıl Maral
  • Gül Pamukçu
  • Betül Özel
  • Mehmet Karamercan

Received Date: 14.09.2010 Accepted Date: 18.09.2010 Eurasian J Emerg Med 2011;10(2):60-64


To determine the causes of overcrowding in the Adult Emergency Department (ED) of Gazi University Hospital and assess the validation of the “National Emergency Departments Overcrowding System” (NEDOCS) scale among international EDs and EDs of various sizes.

Materials and Methods:

Administrative data collected prospectively in the adult ED of a university-affi liated hospital in Ankara between March 31st and April 7th, 2008. A total of 918 patients who were 18 years and older and who had presented to the ED were included in the study. The factors causing overcrowding in the ED and the correlation between the NEDOCS scale and ED staff ’s perception for overcrowding were determined.


The most important cause of overcrowding was determined to be the inability to transfer patients to inpatient beds in a timely manner. No signifi cant diff erence was found for the perception of overcrowding among the ED staff . The coeffi cient of determination was quite low for the regression model, in which the NEDOCS scale was the independent variable and scores of the ED staff regarding the perception of overcrowding were dependent variables (R2=0.064). When the threshold value for the ED overcrowding was determined as 199, the sensitivity of the NEDOCS scale was measured at 92%; however, specifi city was found to be quite low (32%). The area under the ROC curve was 0.617 and it was not statistically signifi cant.


In order to explain the perception of overcrowding for the Adult ED staff at Gazi University Hospital, more variables were needed in addition to the NEDOCS components.

Keywords: Emergency department, overcrowding, NEDOCS