JMIR Publications

ABSTRACT

Background:

Emergency department (ED) overcrowding is a significant global challenge with profound implications for patient outcomes, healthcare delivery, and public health. Addressing this issue requires comprehensive monitoring of patient flow, supported by a well-structured system of performance indicators. Identifying the root causes of overcrowding is crucial for developing targeted, evidence-based indicators to guide national policies. Hence, this study was conducted to systematically review the indicators used across different countries to measure ED overcrowding, aiming to inform strategies for improving ED capacity management and optimizing patient care.

Objective:

The primary objective of this study is to systematically identify and outline the indicators used to evaluate ED overcrowding across a range of hospital settings globally.

Methods:

A scoping review was conducted from October to November 2023. The selected articles were based on predefined criteria. The inclusion criteria require the articles reported in English and related to the keywords, published between 2013 and 2023, and include any study design (qualitative or quantitative). The databases used were PubMed, Emerald Insight, Google Scholar, and Scopus. The identified indicators were descriptively categorised according to input, throughput and output components based on the ED crowding model framework by Asplin et al. 2003 and summarised based on the indicators ranked from frequently used to the least.

Results:

Out of 1,347 articles screened, 117 articles were included in the study. A total of 314 indicators were retrieved and then consolidated into 26 distinct indicators. The majority (68.8%) fall within the throughput component, followed by 19.7% in the output component, while the input component accounts for the smallest proportion at 11.5%.

Conclusions:

This study highlights that throughput indicators were more prominently studied as key metrics in measuring ED overcrowding. The most frequently utilised throughput (TP) indicator is the ED length of stay, followed by waiting time and the rate of patients leaving without being seen. The review further demonstrates that length of stay (LOS) serves as a critical marker of systemic bottlenecks and operational inefficiencies within EDs. The findings provide valuable insights for policymakers to refine and strengthen existing indicators, helping to address and mitigate the issue of ED overcrowding.