Emergency department crowding in the modern era: a systematic review (2018-2025).

Area of Science:

• Emergency Medicine
• Healthcare Management
• Public Health

Background:

• Emergency department (ED) crowding is a complex global challenge.
• The COVID-19 pandemic has exacerbated existing issues and introduced new ones.
• Understanding the multifaceted causes and consequences of ED crowding is critical for effective intervention.

Purpose of the Study:

• To systematically review the causes, effects, and interventions for emergency department crowding.
• To analyze challenges amplified by the COVID-19 pandemic.
• To identify effective strategies for mitigating ED crowding.

Main Methods:

• Systematic review following PRISMA guidelines.
• Searched MEDLINE, CINAHL, and Web of Science (Jan 2018-Jan 2025).
• Included studies evaluating crowding causes, consequences, or interventions; assessed quality using SIGN tools.

Main Results:

• 226 studies met inclusion criteria; most were retrospective and of low to acceptable quality.
• Key drivers include high patient volumes, limited primary care access, staffing shortages, and hospital boarding.
• Adverse effects encompass increased mortality, treatment delays, and reduced patient satisfaction; interventions like provider-in-triage and split-flow models show promise.

Conclusions:

• ED crowding is a persistent issue with significant clinical and operational impacts.
• While interventions exist, high-quality evidence is limited.
• System-level, multifaceted solutions are necessary to address ED crowding effectively.