title: Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA ; Department of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA ; Department of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Robinson
authors.affiliation: Department of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Garrett
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA.
authors.forename: Kellie
authors.initials: K
authors.lastname: Bunch
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Huggins
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Watson
authors.affiliation: Department of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USA.
authors.forename: Joni
authors.initials: J
authors.lastname: Daniels
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Banks
authors.affiliation: Department of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: D'Etienne
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA ; Department of Emergency Medicine, Baylor University Medical Center, 3501 Junius Street, Dallas, TX 75246, USA.
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Zenarosa