SynthesisAnnals of emergency medicine2008
Systematic review of emergency department crowding: causes, effects, and solutions.
Synthesis in Annals of emergency medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03102216 (An Assessment of the Impact of Enhanced Workflow Patterns Associated With Upfront, Early Point-of-care Testing on Costs, Waiting and Disposition Times in an Emergency Department), which is not on this map. Cited by 512 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
An Assessment of the Impact of Enhanced Workflow Patterns Associated With Upfront, Early Point-of-care Testing on Costs, Waiting and Disposition Times in an Emergency Department
Who cites it
512 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- Emergency department crowding in the modern era: a systematic review (2018-2025).Clinical and experimental emergency medicine · 2026Pooled it
- Effectiveness and safety of emergency department-based streaming interventions for low-acuity utilizers - systematic review and meta-analysis.BMC emergency medicine · 2026Pooled it
- Pooled it
- Safety and Efficacy of Digital Check-in and Triage Kiosks in Emergency Departments: Systematic Review.Journal of medical Internet research · 2025Pooled it
- Distances to emergency departments and non-urgent utilization of medical services: a systematic review.Global health action · 2024Pooled it
- Prolonged length of stay and associated factors among emergency department patients in Ethiopia: systematic review and meta-analysis.BMC emergency medicine · 2024Pooled it
- Acute assessment services for patient flow assistance in hospital emergency departments.The Cochrane database of systematic reviews · 2023Pooled it
- Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- Advanced triage protocols in the emergency department: A systematic review and meta-analysis.Revista latino-americana de enfermagem · 2022Pooled it
- Prospective blinded interim evaluation of a portable radiofrequency device TES HT to support triage in emergency department patients with mild head trauma or acute neurological symptoms.BMC emergency medicine · 2026Trial
- Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?BMC emergency medicine · 2024Trial
- Applying Sydney Triage to Admission Risk Tool (START) to improve patient flow in emergency departments: a multicentre randomised, implementation study.BMC emergency medicine · 2024Trial
- Discharge in the a.m.: A randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.Journal of hospital medicine · 2023Trial
- Trial
- Association of a Callback Program With Emergency Department Revisit Rates Among Patients Seeking Emergency Care.JAMA network open · 2022Trial
- Prospective evaluation of a large language model clinical decision support system in the emergency department.Nature medicine · 2026Observational
- A data-driven digital twin of emergency department flow to quantify congestion dynamics and test operational resilience.Internal and emergency medicine · 2026Article
- Forecast-Driven Dynamic Physician Staffing in a Pediatric Emergency Department: A Prospective Quasi-Experimental Pilot Study.Journal of medical systems · 2026Article
- Emergency Department Overcrowding Despite Lower Post-Pandemic Volumes: A Multicenter Study.Journal of clinical medicine · 2026Article
- Integrating the interpretable machine learning Score for Emergency Risk Prediction (SERP) with emergency department triage to better predict 30-day mortality.Clinical and experimental emergency medicine · 2026Article
452 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
Abstract
Emergency department (ED) crowding represents an international crisis that may affect the quality and access of health care. We conducted a comprehensive PubMed search to identify articles that (1) studied causes, effects, or solutions of ED crowding; (2) described data collection and analysis methodology; (3) occurred in a general ED setting; and (4) focused on everyday crowding. Two independent reviewers identified the relevant articles by consensus. We applied a 5-level quality assessment tool to grade the methodology of each study. From 4,271 abstracts and 188 full-text articles, the reviewers identified 93 articles meeting the inclusion criteria. A total of 33 articles studied causes, 27 articles studied effects, and 40 articles studied solutions of ED crowding. Commonly studied causes of crowding included nonurgent visits, "frequent-flyer" patients, influenza season, inadequate staffing, inpatient boarding, and hospital bed shortages. Commonly studied effects of crowding included patient mortality, transport delays, treatment delays, ambulance diversion, patient elopement, and financial effect. Commonly studied solutions of crowding included additional personnel, observation units, hospital bed access, nonurgent referrals, ambulance diversion, destination control, crowding measures, and queuing theory. The results illustrated the complex, multifaceted characteristics of the ED crowding problem. Additional high-quality studies may provide valuable contributions toward better understanding and alleviating the daily crisis. This structured overview of the literature may help to identify future directions for the crowding research agenda.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.