Emergency Department Wait Times: A Critical Review and a Proposed Syndemic Framework

Timely access to Emergency Department (ED) care is a critical health system challenge that cannot be understood solely through ED operations. Existing frameworks for understanding ED wait times have rarely been critically examined collectively. We conducted a critical review of ED wait time frameworks identified through searches of PubMed, Scopus, and Google Scholar. Drawing on synthesis and principles of syndemic theory, we developed a novel framework. Five framework types were identified, which provide limited emphasis on dynamic and potentially reinforcing interactions among factors operating across different levels of the health system. Our proposed framework conceptualizes prolonged ED wait times emerging from interactions between ED management and ED service-utilization pressures within a broader health system context shaping these interactions. Our framework offers health system leaders an integrated lens for identifying interconnected pressures and may support coordination of ED interventions with strategies addressing healthcare-access barriers and system-level constraints.