Multidimensional emergency department overcrowding measurement tools: a scoping review

Overcrowding in the Emergency Department (ED) is a growing worldwide issue with potentially severe adverse impacts on patients and the healthcare system. Accurately measuring overcrowding in the ED is essential to understand the severity of the problem and to evaluate the effectiveness of proposed solutions. The objective of this review is to provide an overview of existing multidimensional measurement tools for ED overcrowding and to evaluate the suitability of using these measures across diverse settings. This scoping review adhered to the PRISMA-ScR checklist and followed the Arksey and O’Malley framework. The researchers comprehensively searched the literature across PubMed, Embase, Web of Science, Scopus, and CINAHL. The search strategy employed Boolean operators with terms related to “emergency department”, “overcrowding”, and “measurement tools”. Data extraction focused on each tool’s strengths, weaknesses, and contextual applicability. Study selection was documented using a PRISMA flow diagram and data were synthesized narratively. R was used to generate descriptive visualizations of the extracted data. After duplicate removal, 1,974 papers were identified from the databases. There were 87 studies met the inclusion criteria, ranging from 2003 to 2025, and mostly conducted in the USA. Twelve ED overcrowding measurement tools were identified: NEDOCS, PEDOCS, CEDOCS, EDWIN, occupancy rate, SONET, ICMED, READI, mSEAL, ED workload rate, ED work score, and EDCS. The most frequently used and validated tools were NEDOCS, EDWIN, and occupancy rate. This scoping review provided a comprehensive synthesis of multidimensional measurement tools for ED overcrowding, highlighting their characteristics, existing evidence, strengths, limitations, and applicability. This study highlights the importance of selecting measurement tools that align with institutional needs to support effective monitoring and management of ED overcrowding. Obstacles and future directions for using existing tools were identified. There is a need for standardized definitions and flexible, adaptable tools capable of addressing the diverse operational landscapes of EDs globally.