ArticleBMC emergency medicine2025
Operational challenges and adaptive leadership in emergency departments in the United States of America: a mixed-methods analysis.
Article in BMC emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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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.
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.
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Who cites it
2 citing papers in PubMed.
- Implementation Science for Emergency Physicians: A Schematic Diagram and Step-By-Step Guidance to Implement Evidence-Based Innovations.Journal of the American College of Emergency Physicians open · 2026Review
- Antiviral Dispensing for Influenza Outpatients Younger Than 65 Years With Comorbidities: A Retrospective Cohort Study.Open forum infectious diseases · 2026Article
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
backgroundEmergency departments (EDs) are important access points for acute care in the U.S. healthcare system. However, persistent operational challenges, ranging from overcrowding to staffing shortages continue to threaten care quality and provider well-being. While existing literature has explored patient-level outcomes and system bottlenecks, the perspectives of ED leadership remain underexamined.
objectiveTo explore how ED leaders across diverse facility types perceive, prioritize, and respond to operational challenges, and to identify context-sensitive strategies for improvement.
methodsWe employed a sequential explanatory mixed-methods design, combining survey data (n = 40) with semi-structured interviews (n = 8) of ED leaders representing rural, urban, and academic settings. Quantitative data were analyzed descriptively, while qualitative data underwent thematic analysis. Findings were triangulated to identify patterns across five operational domains: capacity management, staffing models, care coordination, digital integration, and patient experience.
resultsLeaders expressed near-universal satisfaction with triage protocols (94%) and onboarding practices (76%), signaling possible successful standardization. However, significant role-based and contextual divergences emerged, particularly around staffing adequacy, handoff quality, and revenue cycle awareness. Rural leaders reported greater innovation despite resource constraints, leveraging simplified protocols and creative staffing models. Strategic priorities such as space optimization and technology integration were often misaligned with operational realities, highlighting systemic implementation barriers.
conclusionED leadership effectiveness hinges on adaptive strategies tailored to local contexts. While certain practices can be standardized, many require customization based on facility type, leadership role, and resource availability. These findings support a differentiated approach to ED improvement, one that balances evidence-based protocols with entrepreneurial adaptability and cross-professional collaboration. CLINICAL TRIAL NUMBER: Not applicable.
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Registered trials
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