STRATEGIES FOR IMPROVING PATIENT FLOW AND REDUCING EMERGENCY DEPARTMENT CROWDING: A SYSTEMATIC REVIEW
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Keywords
emergency department, patient flow, crowding, throughput, efficiency, healthcare management, systematic review
Abstract
Background: Emergency department (ED) crowding is a critical global issue that compromises patient safety, increases waiting times, and reduces the overall quality of care. Efficient patient flow management is essential to address these challenges and optimize the use of healthcare resources. Objective: This systematic review aims to identify, evaluate, and synthesize evidence on strategies that improve patient flow and reduce crowding in emergency departments. Methods: A systematic search was conducted across PubMed, Scopus, CINAHL, and Web of Science databases for studies published between 2015 and 2025. Keywords included “patient flow,” “emergency department,” “crowding,” “throughput,” and “efficiency interventions.” Studies focusing on interventions designed to improve ED operations, reduce waiting times, or enhance throughput were included. Data were extracted and analyzed to identify common themes, intervention types, and reported outcomes. Results: Thirty-seven studies met the inclusion criteria. The most effective strategies were categorized into three domains: (1) input management, including triage nurse practitioners, fast-track systems, and ambulance diversion policies; (2) throughput improvement, such as Lean and Six Sigma methodologies, bedside registration, and point-of-care testing; and (3) output optimization, including the use of observation units, inpatient bed management, and hospital-wide patient flow coordination. Multidisciplinary team collaboration and real-time data dashboards were also found to significantly improve coordination and reduce length of stay. Most interventions demonstrated a reduction in ED waiting times, increased patient satisfaction, and improved staff efficiency. Conclusion: A combination of input, throughput, and output strategies, supported by leadership commitment and interprofessional collaboration, is essential to mitigate ED crowding and improve patient flow. Implementing data-driven approaches, enhancing communication between departments, and adopting process-improvement frameworks are key to sustaining long-term efficiency gains. Future research should focus on integrated system-wide models and the cost-effectiveness of specific interventions.
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