Overcrowding in Emergency Departments: A Scoping Literature Review

Yıl 2025, Cilt: 8 Sayı: 2, 94 - 100, 26.06.2025

Mustafa Altun , Emre Kudu

https://doi.org/10.54996/anatolianjem.1684632

Öz

Emergency department (ED) overcrowding occurs when healthcare demand exceeds available resources, significantly impairing the quality of patient care and the efficiency of the healthcare system. This review comprehensively analyzes the definition, causes, measurement methods, consequences, and proposed solutions of ED overcrowding. ED crowding is marked by prolonged waiting times, disrupted patient flow, interrupted medical service delivery, and risks to patient and staff safety. Patient-related factors include the preference for EDs for non-emergent conditions, complicated health issues in the elderly, low health literacy, and frequent visits by individuals with chronic illnesses. Systemic factors involve access block, staff shortages, inefficiencies in discharge processes, and delays in diagnostic tests and consultations. External factors include inadequate primary care services, socioeconomic disparities, seasonal fluctuations, epidemics, and natural disasters. To evaluate ED crowding, measurement tools such as the National Emergency Department Overcrowding Scale and the Emergency Department Work Index are utilized; however, the lack of standardization and variability across different hospital types remains a point of contention. Overcrowding compromises patient safety, leading to treatment delays, increased medical errors, staff burnout, and escalating healthcare costs. Proposed solutions include short-term measures (fast-track units, early discharge planning, patient redirection), long-term strategies (enhancing primary care, establishment of acute care centers, management of inpatient bed capacity, and planning to reduce the burden of chronic illnesses), and technological approaches (artificial intelligence, simulation models, telemedicine, and patient tracking technologies). Gaps in the literature include issues related to the validity and reliability of measurement tools, limited data on the economic and clinical impacts of interventions, insufficient research in low- and middle-income countries, and inadequate examination of patient behaviors and the psychological effects on healthcare personnel. The effective management of ED crowding requires the coordinated implementation of systemic reforms, innovative technologies, and collaborative efforts across clinical, academic, and policy-making domains. This is a critical step toward enhancing patient safety, improving clinical outcomes, and ensuring the sustainability of the healthcare system.

Anahtar Kelimeler

Access block , emergency department , patient flow , overcrowding

Etik Beyan

This is an invited scoping review and does not involve human or animal subjects. Therefore, ethical approval was not required

Acil Servislerde Aşırı Kalabalıklık: Kapsayıcı Bir Literatür İncelemesi

Öz

Acil servis (AS) kalabalıklığı, sağlık hizmeti talebinin mevcut kaynakları aşmasıyla ortaya çıkan ve hasta bakım kalitesini, sağlık sisteminin verimliliğini olumsuz etkileyen ciddi bir sorundur. Bu derleme, AS kalabalıklığının tanımını, nedenlerini, ölçüm yöntemlerini, sonuçlarını ve çözüm önerilerini ayrıntılı bir şekilde ele almaktadır. AS kalabalıklığı, uzun bekleme süreleri, hasta akışında aksamalar, tıbbi hizmet sunumunda kesintiler ve hasta ile sağlık çalışanlarının güvenliğine yönelik risklerle karakterizedir. Hasta kaynaklı faktörler arasında acil olmayan durumlar için AS’yi tercih etme, yaşlı nüfusun komplike sağlık sorunları, düşük sağlık okuryazarlığı ve kronik hastalıklara sahip bireylerin sık ziyaretleri yer alır. Sistemsel faktörler, yatış bloğu, personel eksikliği, taburculuk süreçlerindeki verimsizlik ile tetkik ve konsültasyon gecikmelerini içerir. Dış faktörler ise yetersiz birincil bakım hizmetleri, sosyoekonomik eşitsizlikler, mevsimsel dalgalanmalar, salgınlar ve doğal afetlerdir. AS kalabalıklığını değerlendirmek için National Emergency Department Overcrowding Scale ve Emergency Department Work Index gibi ölçüm araçları kullanılır; ancak bu araçların standartlaşma eksikliği ve hastane türlerine göre değişkenliği tartışmalıdır. AS kalabalıklığı, hasta güvenliğini tehdit eder, tedavi gecikmelerine, tıbbi hatalarda artışa, personel tükenmişliğine ve sağlık maliyetlerinde artışa neden olur. Çözüm önerileri; kısa vadeli (hızlı bakı, erken taburculuk planları, hasta yönlendirmeler), uzun vadeli (birinci basamak hizmetlerinin geliştirilmesi, akut bakım merkezlerinin kurulması, yatak kapasitesinin yönetilmesi, kronik hasta yükünü azaltmaya yönelik planlamalar) ve teknolojik (yapay zeka, simülasyon, tele-tıp, hasta takip teknolojileri) yaklaşımları kapsar. Literatürdeki boşluklar, ölçüm araçlarının geçerlilik ve tutarlılık sorunları, müdahalelerin ekonomik ve klinik etkilerine dair sınırlı veri, düşük ve orta gelirli ülkelerdeki araştırma eksiklikleri ile hasta davranışları ve personel üzerindeki psikolojik etkilerin yeterince incelenmemesini içerir. AS kalabalıklığının etkili yönetimi, sistemik reformların, yenilikçi teknolojilerin ve klinik, akademik ve politik iş birliğinin koordineli bir şekilde uygulanmasını gerektirir. Bu, hasta güvenliğini artırmak, klinik sonuçları iyileştirmek ve sağlık sisteminin sürdürülebilirliğini sağlamak için kritik bir adımdır.

Anahtar Kelimeler

Yatış bloğu , acil servis , kalabalıklık , hasta akışı

Kaynakça

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