ReviewOpen access emergency medicine : OAEM2022
Measures of Emergency Department Crowding, a Systematic Review. How to Make Sense of a Long List.
Review in Open access emergency medicine : OAEM, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers.
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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.
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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.
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Who cites it
41 citing papers in PubMed.
- Factors affecting time-to-disposition at a district hospital emergency centre in Cape Town, South Africa.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026Article
- Barriers to Protocol Adherence in Emergency Departments and Evidence-Based Strategies for Successful Implementation: A Scoping Review.Journal of clinical medicine · 2026Review
- Article
- Crowding in real-time: an artificial intelligence-based model to manage crowding in the emergency department (CRAMMED Study).BMC emergency medicine · 2026Article
- Overcrowding Indicators in Emergency Departments Across Countries: Scoping Review.Interactive journal of medical research · 2026Review
- "The 4D Approach"-An Effective Strategy to Improve Emergency Department Boarding and Operational Outcomes.Journal of the American College of Emergency Physicians open · 2026Article
- National landscape of pediatric and adult inpatient sickle cell disease care.Blood advances · 2026Article
- Impact of adding a medical intern to the emergency department night shift.BMJ open quality · 2026Article
- Evaluating an AI Decision Support System for the Emergency Department: Retrospective Study.JMIR AI · 2026Article
- Data-driven queueing modelling: a simulation case study of emergency department crowding.BMJ health & care informatics · 2026Article
- Development and Internal Validation of an Early Warning Predictive Model for Critically Ill Patients in the Emergency Department Utilizing Easily Obtainable Clinical Indicators.Risk management and healthcare policy · 2026Article
- Evaluation of an intelligent inpatient transportation system in a large tertiary hospital: a full implementation case review.Frontiers in public health · 2026Article
- A local operational definition of pediatric emergency department overcrowding: an 8-year retrospective observational cohort study from the OACS+ project.Frontiers in pediatrics · 2026Article
- Causes and consequences of overcrowding in emergency departments and its impact on patients' care at main governmental hospitals in Gaza Strip: a cross-sectional study.BMC emergency medicine · 2025Article
- Measuring emergency department crowding: comparing the NEDOCS and Fenice crowding scores against staff perception.Internal and emergency medicine · 2025Article
- Evaluation of the performance of telephone triage service.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Cost-Effectiveness of the CADScor System in Low-Risk Patients Presenting to the Emergency Department with Chest Pain.PharmacoEconomics - open · 2025Article
- Emergency Department Boarding, Crowding, and Error.Journal of the American College of Emergency Physicians open · 2025Article
- Length of stay in the emergency department and its associated input-, throughput-, and output factors at two hospitals in Sweden.BMC emergency medicine · 2025Article
- Resident clinical dashboards to support precision education in emergency medicine.AEM education and training · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Emergency department (ED) crowding, a common and serious phenomenon in many countries, lacks standardized definition and measurement methods. This systematic review critically analyzes the most commonly studied ED crowding measures. We followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We searched PubMed/Medline Database for all studies published in English from January 1st, 1990, until December 1st, 2020. We used the National Institute of Health (NIH) Quality Assessment Tool to grade the included studies. The initial search yielded 2293 titles and abstracts, of whom we thoroughly reviewed 109 studies, then, after adding seven additional, included 90 in the final analysis. We excluded simple surveys, reviews, opinions, case reports, and letters to the editors. We included relevant papers published in English from 1990 to 2020. We did not grade any study as poor and graded 18 as fair and 72 as good. Most studies were conducted in the USA. The most studied crowding measures were the ED occupancy, the ED length of stay, and the ED volume. The most heterogeneous crowding measures were the boarding time and number of boarders. Except for the National ED Overcrowding Scale (NEDOCS) and the Emergency Department Work Index (EDWIN) scores, the studied measures are easy to calculate and communicate. Quality of care was the most studied outcome. The EDWIN and NEDOCS had no studies with the outcome mortality. The ED length of stay had no studies with the outcome perception of care. ED crowding was often associated with worse outcomes: higher mortality in 45% of the studies, worse quality of care in 75%, and a worse perception of care in 100%. The ED occupancy, ED volume, and ED length of stay are easy to measure, calculate and communicate, are homogenous in their definition, and were the most studied measures.
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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.