Table 2 Adverse consequences of EDs crowding

Adverse consequences on patients

• Increase delay to treatment, patients LWBS [19, 32, 36,37,38,39,40] and subsequently walkouts due to perceived ED LOS [41]

• Increase dissatisfaction [42,43,44,45] and medical malpractice [46,47,48,49]

• Increase adverse effect [50] and deaths [50,51,52,53,54,55,56,57,58,59,60,61]

• Increase readmissions [51, 62], hospitalization [50, 52, 53] and costs for healthcare [54]

Adverse consequences on healthcare delivery system

• Increase workload [63], delay service provision/decision making and increased ED LOS [53, 54, 56, 60, 61, 63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78]

• Increase delay to management of outpatients [79] and overuse of ED facilities [64]

• Decrease efficiency, and increase costs of healthcare [17, 36, 40, 50, 61, 80, 81]

• Decrease consideration for infection prevention and control measures [82]

• Decrease time and precise to examination patients’ conditions [71], compliance to standardization of healthcare [52] and quality of healthcare [39, 42, 63, 83,84,85,86,87]

• Discharging of patients with high-risk clinical features [51] and diverting of patients to proper facilities [18]

• Increase patients readmission rate [42] and admission rate to hospital wards [64]

Decrease discharging rate of patients [37, 51, 57, 59, 66, 79, 88] and admission of patients [89]