Interventions to reduce emergency department overcrowding and their effects on patient outcomes: a mixed-methods systematic review and meta-analysis
Abstract
BACKGROUND: Overcrowding in emergency departments (EDs) leads to inadequate patient outcomes and increased operational costs. These complications contribute to heightened stress on healthcare systems thus, effective methods to reduce ED overcrowding are necessary to improve patient flow and overall care quality. AIM: This mixed-method systematic review and meta-analysis evaluates the effectiveness of interventions such as Fast-Track, Team Triage, and Point-Of-Care Testing (POCT) in reducing ED overcrowding and improving patient flow metrics, including ED length of stay (LOS), wait times, and discharge times, to provide evidence-based recommendations for policy and practice in emergency healthcare. METHODS: This review complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases (PubMed, ScienceDirect and Google Scholar) were systematically searched for studies published between 2015 and 2025 assessing interventions to reduce ED overcrowding. A structured risk-of-bias assessment (RoB 2, ROBINS-I, JBI, MMAT) indicated overall acceptable methodological quality, with expected limitations related to non-randomized designs and limited blinding. Mean LOS was pooled using random-effects meta-analysis in RevMan, with heterogeneity assessed and secondary outcomes summarized narratively. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO 2025: CRD42025634351). RESULTS: This…
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