Challenges and Contributing Factors to Emergency Department Overcrowding in Taiwan After the Lunar New Year Holiday:...

Emergency department (ED) overcrowding has become a widespread global problem, with multi-factorial causes spanning input, throughput, and output domains. In Taiwan, the unique context of universal health coverage and a severe nursing shortage further complicates the situation. The Lunar New Year holiday period is associated with increased ED demand, yet the extent, causes, and responses to post-holiday overcrowding remain unclear.

We conducted a descriptive observational survey targeting ED directors from all certified emergency care hospitals in Taiwan one week after the 2024 Lunar New Year holiday (February 8 to 14). The questionnaire compared operational status with the same period in previous years, assessing patient volume, bed availability, staffing, perceived causes of overcrowding, and implemented countermeasures. Data from 59 responding hospitals were analyzed using Chi-square, ANOVA/Kruskal-Wallis tests, and logistic regression to identify factors associated with unusual operational status and prolonged waiting for beds.

Of the 59 hospitals (18 medical centers, 20 regional hospitals, 21 district hospitals), 41 (69.5%) reported abnormal post-holiday ED operations, including severe overcrowding, hospitalization difficulties, and increased bed full notifications. In multivariate analysis, prolonged waiting for beds was the only factor significantly associated with severe operational anomalies (odds ratio [OR] = 11.31, p = 0.019). Factors contributing to prolonged waiting included decreased ED nurse staffing (OR = 5.40, p = 0.021), closure of general ward beds (OR = 3.26, p = 0.032), and closure of ICU beds (OR = 6.27, p = 0.025). A one-nurse decrease increased the odds of waiting for beds by 25% ( p = 0.008), and a 1% ward bed closure increased the odds by 7.1% ( p = 0.012). Although 35 hospitals implemented countermeasures such as opening extra beds or restricting transfers, only 14.3% reported significant improvement.

Reduced nursing staff and closure of general wards and ICU beds were strongly associated with prolonged waiting for beds and ED overcrowding after the Lunar New Year holiday. Current hospital-level measures have limited and temporary effects. A comprehensive approach integrating ED process optimization, hospital-wide management strategies, and community-level interventions is needed to improve bed allocation efficiency, strengthen nursing workforce sustainability, and alleviate overcrowding in Taiwan's EDs.