ORIGINAL RESEARCH article
Front. Public Health
Sec. Disaster and Emergency Medicine
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1691633
Emergency Department Overcrowding: First Swiss Application of the Emergency Department Work Index (EDWIN) and Risk Factors for Overcrowding
Provisionally accepted
- 1UniversitatsSpital Zurich, Zürich, Switzerland
- 2Klinik Gut Sankt Moritz, Saint Moritz, Switzerland
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Introduction Emergency department (ED) overcrowding is associated with increased waiting time, reduced patient satisfaction and decreased quality of care. Numerous validated scores are available to assess ED overcrowding. The Emergency Department Work Index (EDWIN) is the most established score quantifying the ED overcrowding. We assessed the applicability of the EDWIN in a Swiss ED and investigated further predictors for ED overcrowding. Methods In a retrospective analysis, we enrolled consecutive ED visits of a tertiary care hospital between December 1st-31st, 2016. The median EDWIN per hour was defined as the first endpoint. To investigate predictors for overcrowding, we grouped the ED visits with an EDWIN ≤2 as not overcrowded and >2 as overcrowded and performed multivariable regression analysis. Results The median EDWIN per hour was 1.4 (IQR 1.0 – 1.9). In 394 calculations (53%), the EDWIN was active, 189 calculations (25.4%) showed a very busy ED and in 161 observations (21.6%), the ED severely overcrowded. In average, the ED was severely overcrowded 6 times per day. The highest EDWIN was reported on Saturdays (mean 2.1 (SD 1.2)) and Sundays (mean 1.7 (SD 1.0). During weekends, overcrowding was from 8 pm to 05 am, EDWIN ranged from 2.2 – 3.1. During the week the mean EDWIN ranged from 1.3 - 1.6. The reduced number of emergency physicians during night shifts (p<0.001), increased number of patients in the ED treatment area (p<0.001), patients waiting for admission to the ward (p<0.001), weekend periods (p=0.001) and the number of isolated ED patients due to infections (p<0.001) had a highly significant association with overcrowding. In case of overcrowding, the waiting time was prolonged (p=0.034) Conclusion The EDWIN was easily applicable in a tertiary care Swiss ED, objectively displayed severe overcrowding during the weekend nights, and was strongly associated with the number of available attending emergency physicians, number of patients in the ED treatment area, patients waiting for admission to the ward, weekend periods and the number of isolations.
Keywords: emergency department, Overcrowding, Emergency Department Work Index (EDWIN), predictors for ED overcrowding, ED staffing
Received: 24 Aug 2025; Accepted: 22 Oct 2025.
Copyright: © 2025 Herzog, Luster, Keller Lang and Slankamenac. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ksenija Slankamenac, ksenija.slankamenac@usz.ch
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