Challenges, consequences, and lessons for way-outs to emergencies at hospitals: a systematic review study

BMC Emerg Med. 2019 Oct 30;19(1):62. doi: 10.1186/s12873-019-0275-9.


Background: Emergency Department (ED) overcrowding adversely affects patients' health, accessibility, and quality of healthcare systems for communities. Several studies have addressed this issue. This study aimed to conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals.

Methods: Original research articles on crowding of emergencies at hospitals published from 1st January 2007, and 1st August 2018 were utilized. Relevant studies from the PubMed and EMBASE databases were assessed using suitable keywords. Two reviewers independently screened the titles, abstracts and the methodological validity of the records using data extraction format before their inclusion in the final review. Discussions with the senior faculty member were used to resolve any disagreements among the reviewers during the assessment phase.

Results: Out of the total 117 articles in the final record, we excluded 11 of them because of poor quality. Thus, this systematic review synthesized the reports of 106 original articles. Overall 14, 55 and 29 of the reviewed refer to causes, effects, and solutions of ED crowding, respectively. The review also included four articles on both causes and effects and another four on causes and solutions. Multiple individual patients and healthcare system related challenges, experiences and responses to crowding and its consequences are comprehensively synthesized.

Conclusion: ED overcrowding is a multi-facet issue which affects by patient-related factors and emergency service delivery. Crowding of the EDs adversely affected individual patients, healthcare delivery systems and communities. The identified issues concern organizational managers, leadership, and operational level actions to reduce crowding and improve emergency healthcare outcomes efficiently.

Keywords: Emergency crowding; Emergency department; Overcrowding.

Publication types

  • Systematic Review

MeSH terms

  • Age Factors
  • Crowding*
  • Diagnostic Techniques and Procedures / statistics & numerical data
  • Emergency Service, Hospital / organization & administration*
  • Health Services Accessibility / organization & administration
  • Hospital Administration
  • Humans
  • Patient Acuity
  • Sex Factors
  • Waiting Lists
  • Workflow