Assessing Emergency Department Crowding: A Structured Literature Review of the National Emergency Department Overcrowding Score

Background: Emergency department crowding requires reliable measurement to distinguish operational pressure from patient severity and clinical outcomes. Objectives: This review evaluated evidence regarding the National Emergency Department Overcrowding Score (NEDOCS) and its potential application in emergency service evaluation. Methods: A structured narrative review examined eight previously selected studies within the reported 2021–2026 eligibility period. Searches reportedly covered PubMed, ScienceDirect, Taylor & Francis, and ProQuest, identifying 126 records. Search dates and several selection procedures remained unverified. Findings were synthesized across crowding perceptions, workload, waiting and boarding, and leaving without being seen. Results: NEDOCS demonstrated agreement with staff perceptions in some settings, while associations with alternative crowding indices and waiting times varied. Workload findings relied on repeated questionnaires, and pediatric leaving without being seen was associated with crowding in adjusted observational analysis. Simulated boarding removal reduced calculated scores without demonstrating clinical benefits. Methodological heterogeneity and incomplete review documentation limited interpretation. Conclusions: NEDOCS may complement existing emergency department performance indicators, but evidence does not establish its effectiveness at Dr. Soeradji Tirtonegoro General Hospital. Local validation, standardized outcome measurement, and transparent review documentation are necessary before implementation.