Emergency Department Crowding and Patient Flow Management

Emergency department (ED) crowding arises when demand for urgent care outstrips available resources, leading to prolonged waiting times, treatment delays and suboptimal patient outcomes. Contributing factors span three interconnected domains: input (volume and acuity of arrivals), throughput (efficiency of assessment, diagnostics and treatment) and output (access to inpatient beds and community services). Crowding has been linked with increased morbidity, staff burnout and diminished patient satisfaction, prompting the adoption of multifaceted management strategies. These include rapid triage systems, fast-track pathways for low-acuity cases, point-of-care testing and digital forecasting tools to anticipate surges in attendances. Lean and Six Sigma methodologies have been applied to streamline clinical workflows, while regional collaborations and extended primary-care hours seek to moderate ED reliance. Effective patient flow management balances real-time bed allocation, dynamic staffing rosters and rapid disposition decisions, thereby reducing boarding of admitted patients in the ED and enhancing overall hospital throughput. Globally, policymakers and healthcare leaders are exploring whole-of-system initiatives—ranging from dedicated psychiatric emergency services to ED-based intensive care units—to alleviate bottlenecks and safeguard patient safety.

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Emergency Department Crowding and Patient Flow Management publication trend

The graph below shows the total number of articles in emergency department crowding and patient flow management across all publications each year (not limited to Nature Index journals).

Technical terms

Emergency department crowding: A state in which patient demand exceeds the capacity of the ED to provide timely care.

Patient flow management: Strategies and processes designed to optimise the movement of patients through input, assessment, treatment and disposition stages.

Triage: The rapid assessment and prioritisation of patients according to the urgency of their medical needs.

Boarding: The practice of holding admitted patients in the ED due to a lack of available inpatient beds.

Forecasting models: Computational approaches, often using statistical or machine learning techniques, to predict future ED demand and occupancy.

References

1. The use of kiosks to improve triage efficiency in the emergency department. npj Digital Medicine (2023).
2. Forecasting emergency department occupancy with advanced machine learning models and multivariable input. International Journal of Forecasting (2024).
3. Emergency department crowding: A systematic review of causes, consequences and solutions. PLOS ONE (2018).
4. Effect of a Regional Dedicated Psychiatric Emergency Service on Boarding and Hospitalization of Psychiatric Patients in Area Emergency Departments. Western Journal of Emergency Medicine (2014).
5. Association of an Emergency Department–Based Intensive Care Unit With Survival and Inpatient Intensive Care Unit Admissions. JAMA Network Open (2019).