# NEDOCS

NEDOCS

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/nedocs`
HTML: https://magentlab.com/docs/nedocs
Markdown: https://magentlab.com/docs/nedocs.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Compute the Weiss 2004 NEDOCS reduced five-variable score from caller-supplied ED patients, ED beds, boarding patients, hospital beds, respirators, longest admitted-patient hours, and last-called registration-to-bed hours, and return the published ≥100 overcrowding cutoff.

## When to use

When an agent has the published snapshot counts and hours for an academic ED and needs the Weiss 2004 reduced-model NEDOCS score, not a diversion or ambulance-bypass order.

## When not to use

- Not a medical device. Not a diversion or ambulance-bypass order.
- magent does not count beds, patients, respirators, or wait times. Caller supplies the published numeric inputs.
- Weiss 2004 reduced five-variable model for academic EDs. The paper omitted the patindex × reg_time interaction from the presented nomogram (about 1% extra variance).
- The linear combination can fall below 0 or above 200. The paper's interpretation scale is 0-200 with 100 as the overcrowding cutoff. magent does not clamp the score and does not invent 0-20/21-60 interval cuts.
- Pediatric-only EDs were not this model. Not a diagnosis of crowding-related harm.

## Formula

```
nedocs_score = -20 + 85.8 * (ed_patients / ed_beds) + 600 * (boarding_patients / hospital_beds) + 13.4 * respirators + 0.93 * admit_time_hours + 5.64 * reg_time_hours
```

## Citation

[Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS)](https://doi.org/10.1197/j.aem.2003.07.017)
Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frankelton M, Schwab R, Stair TO, Vicellio P, Levy D, Brautigan M, Johnson A, Nick TG
Acad Emerg Med. 2004;11(1):38-50
DOI: [10.1197/j.aem.2003.07.017](https://doi.org/10.1197/j.aem.2003.07.017)

## Worked example

### Average academic ED at low poles (not busy)

Given: `admit_time_hours=0, boarding_patients=0, ed_beds=50, ed_patients=0, hospital_beds=500, reg_time_hours=0, respirators=0`

1. patindex = 0/50 = 0; admit_index = 0/500 = 0; respirators 0; admit_time 0 h; reg_time 0 h
2. nedocs_score = -20 + 85.8*0 + 600*0 + 13.4*0 + 0.93*0 + 5.64*0 = -20.0; overcrowded false (score < 100)


### Weiss 2004 Figure 3 snapshot (100% full, 10 boarding, 2 respirators)

Given: `admit_time_hours=5, boarding_patients=10, ed_beds=50, ed_patients=50, hospital_beds=500, reg_time_hours=7, respirators=2`

1. patindex = 50/50 = 1.0; admit_index = 10/500 = 0.02; respirators 2; admit_time 5 h; reg_time 7 h
2. nedocs_score = -20 + 85.8*1.0 + 600*0.02 + 13.4*2 + 0.93*5 + 5.64*7 = 148.7; overcrowded true (score ≥ 100). Figure 3 nomogram read about 150.


## Also searched as

- NEDOCS
- National ED Overcrowding Study
- ED overcrowding score
- emergency department overcrowding
- Weiss NEDOCS
- NEDOCS reduced model
- academic ED overcrowding

## Parameters

- `ed_patients` (integer, required): Total patients in the ED (integer 0-200). Weiss 2004 patindex numerator (full rooms + hallways + doubled-up). magent does not count patients.
- `ed_beds` (integer, required): Number of ED beds (integer 1-300). Weiss 2004 patindex denominator. The paper's average academic ED was 50 ED beds. magent does not count beds.
- `boarding_patients` (integer, required): Patients in the ED awaiting inpatient beds (integer 0-200). Weiss 2004 admit-index numerator. magent does not count boarding patients.
- `hospital_beds` (integer, required): Number of hospital beds (integer 1-3000). Weiss 2004 admit-index denominator. The paper's average academic hospital was 500 beds. magent does not count beds.
- `respirators` (integer, required): Patients on respirators in the ED (integer 0-20). Weiss 2004 reduced-model respirators term. magent does not count ventilators.
- `admit_time_hours` (number, required): Hours the longest-waiting admitted patient has been in the ED since registration (0-120). Weiss 2004 reduced-model admit time. Not time since the admission order (that bed-time variable was omitted). magent does not measure wait times.
- `reg_time_hours` (number, required): Hours from registration until the last patient called from the waiting room was called to a bed (0-48). Weiss 2004 reduced-model reg time. magent does not measure wait times.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/nedocs`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "admit_time_hours": "0",
      "boarding_patients": "0",
      "ed_beds": "50",
      "ed_patients": "0",
      "hospital_beds": "500",
      "reg_time_hours": "0",
      "respirators": "0"
    },
    {
      "admit_time_hours": "0",
      "boarding_patients": "0",
      "ed_beds": "50",
      "ed_patients": "0",
      "hospital_beds": "500",
      "reg_time_hours": "0",
      "respirators": "0"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/nedocs

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/nedocs",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frankelton M, Schwab R, Stair TO, Vicellio P, Levy D, Brautigan M, Johnson A, Nick TG",
        "doi": "10.1197/j.aem.2003.07.017",
        "id": "weiss-2004",
        "pmid": "14709427",
        "source": "Acad Emerg Med. 2004;11(1):38-50",
        "title": "Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS)"
      },
      "formula": "nedocs",
      "formula_expression": "nedocs_score = -20 + 85.8 * (ed_patients / ed_beds) + 600 * (boarding_patients / hospital_beds) + 13.4 * respirators + 0.93 * admit_time_hours + 5.64 * reg_time_hours",
      "admit_index": 0.0,
      "admit_time_hours": 0.0,
      "boarding_patients": 0,
      "ed_beds": 50,
      "ed_patients": 0,
      "hospital_beds": 500,
      "nedocs_score": -20.0,
      "overcrowded": false,
      "patindex": 0.0,
      "reg_time_hours": 0.0,
      "respirators": 0
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frankelton M, Schwab R, Stair TO, Vicellio P, Levy D, Brautigan M, Johnson A, Nick TG",
        "doi": "10.1197/j.aem.2003.07.017",
        "id": "weiss-2004",
        "pmid": "14709427",
        "source": "Acad Emerg Med. 2004;11(1):38-50",
        "title": "Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS)"
      },
      "formula": "nedocs",
      "formula_expression": "nedocs_score = -20 + 85.8 * (ed_patients / ed_beds) + 600 * (boarding_patients / hospital_beds) + 13.4 * respirators + 0.93 * admit_time_hours + 5.64 * reg_time_hours",
      "admit_index": 0.0,
      "admit_time_hours": 0.0,
      "boarding_patients": 0,
      "ed_beds": 50,
      "ed_patients": 0,
      "hospital_beds": 500,
      "nedocs_score": -20.0,
      "overcrowded": false,
      "patindex": 0.0,
      "reg_time_hours": 0.0,
      "respirators": 0
    }
  ]
}
```

## Response fields

- `formula` (string): nedocs
- `formula_expression` (string): Weiss 2004 reduced five-variable linear expression
- `ed_patients` (integer): Caller-supplied total ED patients used as the patindex numerator
- `ed_beds` (integer): Caller-supplied ED beds used as the patindex denominator
- `boarding_patients` (integer): Caller-supplied patients awaiting inpatient beds
- `hospital_beds` (integer): Caller-supplied hospital beds used as the admit-index denominator
- `respirators` (integer): Caller-supplied ED respirator count
- `admit_time_hours` (number): Caller-supplied longest admitted-patient hours since registration
- `reg_time_hours` (number): Caller-supplied last-called registration-to-bed hours
- `patindex` (number): ed_patients / ed_beds, 4 decimals (Weiss 2004 patindex)
- `admit_index` (number): boarding_patients / hospital_beds, 4 decimals (Weiss 2004 admit index)
- `nedocs_score` (number): Weiss 2004 reduced-model score, 1 decimal. The paper's interpretation scale is 0-200; the linear combination is not clamped.
- `overcrowded` (boolean): true iff nedocs_score >= 100. Weiss 2004: 100 is the overcrowding cutoff (over 100 represents overcrowding). Not a diversion order.
- `citation` (object): Weiss 2004 Acad Emerg Med citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frankelton M, Schwab R, Stair TO, Vicellio P, Levy D, Brautigan M, Johnson A, Nick TG",
    "doi": "10.1197/j.aem.2003.07.017",
    "id": "weiss-2004",
    "pmid": "14709427",
    "source": "Acad Emerg Med. 2004;11(1):38-50",
    "title": "Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS)"
  },
  "formula": "nedocs",
  "formula_expression": "nedocs_score = -20 + 85.8 * (ed_patients / ed_beds) + 600 * (boarding_patients / hospital_beds) + 13.4 * respirators + 0.93 * admit_time_hours + 5.64 * reg_time_hours",
  "admit_index": 0.0,
  "admit_time_hours": 0.0,
  "boarding_patients": 0,
  "ed_beds": 50,
  "ed_patients": 0,
  "hospital_beds": 500,
  "nedocs_score": -20.0,
  "overcrowded": false,
  "patindex": 0.0,
  "reg_time_hours": 0.0,
  "respirators": 0
}
```

## Errors

- HTTP 400 `invalid_nedocs`: NEDOCS inputs must match Weiss 2004 census, bed, wait, boarding, and critical-care terms from that paper. Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [HOSPITAL](https://magentlab.com/docs/hospital) — Sum the Donze 2013 HOSPITAL integer score (acronym table, max 13) from caller-assigned flags and prior-year admissions and return the derivation-study band (low / intermediate / high).
- [LACE](https://magentlab.com/docs/lace) — Sum van Walraven 2010 Table 3 LACE points from length of stay, acute (emergent) admission, a caller-supplied Charlson integer, and ED visits in the previous 6 months.
- [MEWS](https://magentlab.com/docs/mews) — Compute the Subbe 2001 modified Early Warning Score from systolic BP, heart rate, respiratory rate, temperature, and caller-assigned AVPU.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.