Emergency department overcrowding: causes and solutions : Emergency and Critical Care Medicine

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Original Article

Emergency department overcrowding: causes and solutions

Butun, Ahmet; Kafdag, Elif Ece; Gunduz, Hilal; Zincir, Vedat; Batibay, Mehmet; Ciftci, Kubra; Demir, Dilan; Bayram, Ramazan; Yigit, Elanur

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Emergency and Critical Care Medicine ():10.1097/EC9.0000000000000078, February 8, 2023. | DOI: 10.1097/EC9.0000000000000078
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Emergency departments (EDs) provide 24-hour uninterrupted services to any patient or injured person with a complaint and emergency cases.[1,2] Providing this service to patients in need as soon as possible and prioritizing the most urgent patients are essential.[2–4] However, patients presenting with nonurgent conditions to the ED causes overcrowding.[2,5,6] Emergency department overcrowding is among the biggest and most important problems ED staff experience.[3] The number of ED visits is on the increase and remains an unresolved problem.[7] Emergency department overcrowding has become an important problem for emergency care services worldwide as ED visits gradually increase.[8,9] Some studies have found a relationship between overcrowding and patients’ negative experiences in the ED that lead patients to report reduced satisfaction.[10–12] Furthermore, high workloads and demand for care often cause ED staff to experience burnout syndrome.[13]

There are many complex reasons that underlie ED use and ED overcrowding.[5] For example, patients often prefer to use the ED instead of primary health care services for nonurgent conditions.[7,14] Emergency department overcrowding also significantly affects the satisfaction of ED staff, which is an important concern for ED staff and managers.[7,13,15] Using the ED for nonurgent conditions leads to ED overcrowding, thereby causing many problems related to ED services, staff, and users.[5] Emergency department overcrowding results in long waiting times, delays in the treatment of patients who most require urgent care, decreased patient satisfaction, decreased quality of the health care provided, and increased health care costs.[2,3,12,16–18]

Most previous studies on the reasons for ED use were conducted in high-income countries; thus, this multifaceted issue has not been sufficiently studied in the context of middle- and low-income countries.[5] Identifying the causes of ED use in the context of middle-income countries is necessary because of differences in health care systems and cultural norms between high- and middle-income countries.[5] In addition, statistical data obtained from the Ministry of Health in Turkey showed approximately 118 million in 2016, 124 million in 2017, 165 million in 2018, 178 million in 2019, 129 million in 2020, and 172 million in 2021 (Health Statistics from Ministry of Health, written communication, 2021), which is equivalent to approximately 1475, 1550, 2010, 2145, 1535, and 2050 ED visits per 1000 population, respectively. These statistical data showed that the number of ED visits per annum in Turkey is greater than the country’s total population. Therefore, an investigation into the causes of ED use is needed to provide solutions for alleviating ED overcrowding in Turkey.

This study aimed to identify the causes of ED overcrowding, determine the reasons for people’s use of EDs, and develop solutions for reducing ED overcrowding.


This study used quantitative methods by applying a descriptive approach.

Participants and settings

The participants of this study were patients who visited the ED. No specific inclusion or exclusion criteria were applied for participant selection. A questionnaire was developed and piloted by the researchers (Butun A, Kafdag EE, Gunduz H, Zincir V, Batibay M, Ciftci K, Demir D, Bayram R, Yigit E). The questionnaire was administered to 296 participants between December 20, 2021, and February 18, 2022. The questionnaires were filled out by the researchers (Kafdag EE, Gunduz H, Zincir V, Batibay M, Ciftci K, Demir D, Bayram R, Yigit E) who asked participants questions and received their answers face-to-face. This approach allowed us to obtain reliable data from the participants.

The settings for this study were as follows: Diyarbakir Training and Research Hospital (83 patients), Mardin Training and Research Hospital (59 patients), Kiziltepe Public Hospital (59 patients), Midyat Public Hospital (49 patients), and Ceylanpinar Public Hospital (46 patients). The total population of these 5 settings is currently approximately 2 million, and the hospitals in these settings have a bed capacity of 1750 in total. Thirty-two individuals refused to participate in this study. Table 1 shows the participant characteristics.

Table 1 - Sociodemographic Information of Patients Admitted to the ED
Variables Number (n = 296) Percentage, %
Age, y
 18–30 151 51.0
 31–40 76 25.7
 41–50 38 12.8
 51–60 17 5.8
 ≥61 14 4.7
Marital status
 Married 188 63.5
 Single 108 36.5
 Housewife 111 37.5
 Teacher 16 5.4
 Unemployed 16 5.4
 Nurse 15 5.1
 Doctor 4 1.4
 Other 134 45.2
Educational level
 Primary school 62 20.9
 Secondary school 33 11.1
 High school 72 24.3
 Associate’s degree 19 6.4
 Bachelor’s degree 61 20.6
 MSc 10 3.4
 PhD 2 0.7
 Illiterate 37 12.6
Location of residence
 Diyarbakir 83 27.8
 Mardin 59 19.9
 Kiziltepe 59 19.9
 Midyat 49 16.9
 Ceylanpinar 46 15.5
ED, emergency department; MSc, Master of Science; PhD, Doctor of Philosophy.

Data analysis

The data were analyzed using a descriptive analysis method.

Ethical considerations

Ethical approval was obtained from the Mardin Artuklu University Ethics Committee (date, December 14, 2021; reference, E-76272411-900-36850). In addition, the necessary permission was obtained from the Mardin Provincial Directorate of Health. Written informed consent was obtained from all participants.


The participants’ most common medical complaints when visiting the ED were fatigue (26.7%), headache (23.3%), cough (22%), and other complaints (33.1%) (Table 2).

Table 2 - Most Common Presenting Medical Problems
Complaints Number (n = 296) Percentage, %
Fatigue 79 26.7
Headache 69 23.3
Cough 65 22.0
Vomiting 61 20.6
Sore throat 60 20.3
Abdominal pain 55 18.6
Shortness of breath 50 16.9
Fever 48 16.2
Dizziness 41 13.9
Chest pain 32 10.8
Diarrhea 27 9.1
Blackout 19 6.4
Other 98 33.1

Regarding their reasons for visiting the ED, participants stated that it was because they perceived that their condition was really urgent (62.8%), the ED is open for 24 hours (36.1%), and they receive faster care in the ED (31.4%). In addition, participants stated that they could not make timely appointments to visit outpatient clinics (30.7%), did not want to wait in the queue for outpatient clinics (24.7%), or the outpatient clinics were closed or had no doctor present (24%). Furthermore, patients could visit the ED without making an appointment (21.3%), could receive better care in the ED (15.5%), did not have another hospital or doctor to visit (14.5%), could receive laboratory results faster (11.8%), found staff in the ED to be more interested (10.1%), could access more resources in the ED (8.8%), found ED staff to be more skilled (8.8%), could receive better information about the disease and treatment process in the ED (7.8%), found the ED to be in close proximity with easy access (7.8%), and could receive free care in the ED (6.8%).

In addition, participants stated that they visited the ED based on the suggestions of the people around them—social network (6.1%), the ED was the only option for receiving their regular injections (4.7%), they were satisfied with previous positive experiences in the ED (4.4%), or they were directed to the ED by outpatient clinic doctors (4.4%) or their general practitioner (GP) (4.1%). In addition, some participants stated that their GP was inexperienced (3.4%), they were unable to trust their GP (3.4%), they had problems with the staff at a GP clinic (1.4%), and could solve all medical problems by visiting only one place (the ED) (1.4%). Table 3 shows the participants’ reasons for visiting the ED.

Table 3 - Reasons for Using the ED
Reasons for Using the ED Number (n = 296) Percentage, %
I came to the ED because my condition was really urgent 186 62.8
Emergency departments are open 24/7 107 36.1
I get faster service/care in the ED 93 31.4
Unable to get a timely appointment from an outpatient clinic 91 30.7
I do not want to wait in the queue at an outpatient clinic 73 24.7
Normal outpatient clinics are closed/no available doctors at this time 71 24.0
I can go to the ED without making an appointment 63 21.3
I get better service in the ED 46 15.5
There was no other hospital or doctor I could go to 43 14.5
Getting faster laboratory and radiology results 35 11.8
The staff in the ED are more interested 30 10.1
Availability of more resources such as medical devices, tests, radiology, and laboratory in the ED 26 8.8
Having more skilled staff in the ED 26 8.8
I get better information about my illness and treatment process in the ED 23 7.8
The ED is close to my home/workplace — I have easy access 23 7.8
I do not pay in the ED 20 6.8
I visited the ED with the suggestions of the people around me — social network 18 6.1
The ED was only option for receiving my regular injections 14 4.7
I was satisfied with my previous ED visit / I have positive past experiences 13 4.4
I was referred by the outpatient clinic doctor 13 4.4
I was referred by the GP 12 4.1
I think my GP is inexperienced 10 3.4
I do not trust my GP 10 3.4
All problems are solved quickly by a single doctor in the ED 10 3.4
I had problems with the staff at GP clinic 4 1.4
ED, emergency department; GP, General Practitioner.

The participant’s reported reasons for not using GPs included limited interventions in GP clinics (49.3%), limited resources (44.6%), limited working hours (35.7%), being unable to receive sufficient information about the disease and treatment process (20.4%), lack of interest (18.7%), transportation problems (15.3%), lack of experience with GPs (13.9%), dissatisfaction with GPs (9.5%), perception of patients regarding GP clinics where places providing vaccinations and infant and pregnancy follow-ups (9.2%), lack of trust in GPs (7.8%), and negative past experiences with GPs (7.1%). Of the participants, 16.3% visited the ED after seeing their GP. Such problems with GPs and GP clinics can lead patients to visit the ED rather than their GPs. Hence, improving GP clinics and eliminating problems with GPs could result in patients using those services rather than the ED, which could result in a reduced number of ED visits. Table 4 provides the participants’ reasons for not using GPs.

Table 4 - Participants’ Reasons for Not Visiting Their GP
Reasons for Not Visiting Their GP Number (n = 296) Percentage, %
Limited interventions are performed at GP clinics 145 49.3
Having limited resources 131 44.6
Having limited working hours 105 35.7
I do not get enough information from my GP about my disease and treatment process 60 20.4
I do not get enough interest from my GP 55 18.7
I went to the GP 48 16.3
Because of transportation difficulties 45 15.3
I think my GP is inexperienced 41 13.9
I am not satisfied with my GP 28 9.5
I perceive GP clinics as places where vaccination, baby, and pregnancy follow-up are performed. 27 9.2
I do not trust my GP 23 7.8
I had negative experiences in my previous visits 21 7.1
I had problems with the staff at the GP clinic 6 2.0
GP, General Practitioner.

Regarding solutions for reducing ED overcrowding, this study found that such solutions include increasing the number of qualified staff in the ED (74.3%), improving the appointment system for outpatient clinics (55.4%), making primary health care services more effective (46.3%), increasing the number of ED services and GP clinics (46.3%), and improving the physical, technological, and financial resources and capacity of EDs (37.5%). In addition, informing the community about how to use both EDs and GP clinics appropriately (35.9%), increasing health literacy (35.9%), and improving the working hours of GP clinics (24 hours for some of them) (34.5%) as well as increasing the public’s level of knowledge about EDs and encouraging them to use other health care services instead (30.5%) could also alleviate ED overcrowding. Developing the communication skills of ED staff (16.6%), establishing a telephone helpline patients can call to receive health information (16.2%), supporting ED staff financially and providing social space for them (13.8%), eliminating the negative impact of the media on EDs and ED staff (9.5%), improving coordination between health care services (8.8%), and providing effective and adequate security in EDs (8.1%) could also help to reduce ED attendance. Limitations of outpatient and GP clinics discourage patients from using these health care services and lead to ED use. Therefore, solving problems in outpatient and GP clinics could help reduce ED visits. Further recommendations for reducing ED visits are presented in Table 5.

Table 5 - Recommendations for Reducing ED Attendance
Recommendations for Reducing ED Attendance Number (n = 296) Percentage, %
Increasing the number of qualified staff in the ED 220 74.3
Improving appointment systems for outpatient clinics 164 55.4
Making primary health care services more effective 137 46.3
Increase the number of EDs and GP clinics 137 46.3
Increasing the physical, technological, financial resources, and capacity of EDs 111 37.5
Informing the community about how to use both EDs and GP clinics appropriately 106 35.9
Increasing health literacy 106 35.9
Improving working hours of GP clinics (working 24 h for some of them) 102 34.5
Encouraging the public to increase their level of knowledge about the ED and to use other health care services instead of EDs 90 30.5
Designing the EDs with an appropriate physical structure. 72 24.3
Improving the communication skills of ED staff 49 16.6
Establishing a telephone helpline where people can call and request information, help, and guidance about their health care needs 48 16.2
Creating sufficient social space for staff and providing financial support 41 13.8
Eliminating the negative impact of the media on EDs and their staff 28 9.5
Improving coordination between hospitals and other health care services 26 8.8
Arranging patient transfers and consultations in the hospital 24 8.1
Practicing adequate and effective safety procedures in the ED 24 8.1
ED, emergency department; GP, General Practitioner.

As Table 6 shows, 42.6% of the participants did not perform any procedures related to their health problems before going to the ED, 42.9% took medication to relieve their complaints before coming to the ED, 15.2% tried herbal remedies, and some tried techniques, such as hot-cold application, massage, and respiratory exercise.

Table 6 - Variables
Variables Number (n = 296) Percentage, %
Arrival to the ED
 Private car 140 47.3
 On foot 74 25.0
 By public transportation 73 24.7
 By ambulance 9 3.0
Did you take any action for your medical complaint before coming to the ED?
 Taking medicine 127 42.9
 No 126 42.6
 Herbal treatment 45 15.2
 Hot-cold application 29 9.8
 Massaging 17 5.7
 Respiratory exercises 10 3.4
 Other 6 2.0
Have you visited the outpatient clinic or your GP about your medical problem before visiting the ED?
 Yes 80 27.0
 No 216 73.0
How many times have you been to the ED in the last year?
 1 69 23.3
 2 62 20.9
 3 39 13.2
 4 15 5.1
 5 31 10.5
 6–10 34 11.5
 11+ 46 15.5
Are you satisfied with the care you received in the ED?
 Yes 178 60.1
 No 50 16.9
 Partly 68 23.0
Was the time allocated to you for treatment and care in the ED sufficient?
 Yes 168 56.8
 No 70 23.6
 Partly 58 19.6
Has your medical problem get better after treatment and care you received?
 Yes 131 44.2
 No 44 14.9
 Partly 121 40.9
Would you visit the ED for the same condition in the future?
 Yes 194 65.6
 No 56 18.9
 Partly 46 15.5
If you have the same medical problem in the future, will you consider going to the GP?
 Yes 98 33.1
 No 142 48.0
 Partly 56 18.9
Do you usually come to the ED with someone?
 Yes 229 77.3
 No 41 13.9
 Sometimes 26 8.8
Are the number of staff in the ED sufficient?
 Yes 109 36.8
 No 151 51.0
 Partly 36 12.2
Do you think the ED is overcrowded?
 Yes 231 78.0
 No 25 8.5
 Partly 40 13.5
ED, emergency department; GP, General Practitioner.

Furthermore, 73% of the participants visited the ED directly, and 27% went to an outpatient clinic or GP before their ED visit. Regarding the number of ED visits in the past year, 23.3% of the participants had visited the ED only once, 20.9% visited twice, 13.2% visited 3 times, and 42.6% visited 4 or more times. Of the participants, 60.1% stated that they were satisfied with the care provided in the ED, 16.9% were unsatisfied, and 23.0% were partly satisfied. In addition, 56.8% of the participants stated that the time allocated to them for treatment and care in the ED was sufficient, 23.6% thought that the time allocated for them was not sufficient, and 19.6% were partly satisfied with the time allocated for their treatment and care.

Of the participants, 44.2% stated that their complaints were relieved after treatment and care they received in the ED, 40.9% stated that their complaints partly improved, and 14.9% stated that their complaints continued after receiving care in the ED. Furthermore, 65.6% of the participants stated that, if the same problems were to occur in the future, they would visit the ED again, 18.9% stated that they would not visit again, and 15.5% would possibly visit the ED again. In addition, 48% of the participants stated that, if their complaints returned in the future, they may not visit their GP, 33.1% stated that they would choose their GP, and 18.9% may choose to use their GP. Of the participants, 78% stated that the EDs were overcrowded and 8.5% stated that they were not. All the aforementioned variables are provided in Table 6.


The ED is the first-place patients visit when they need urgent treatment.[3] Based on statistics provided by the Ministry of Health in Turkey, EDs in Turkey appear to be unable to handle increases in the population and number of ED visits. Therefore, determining the reasons for ED overcrowding is crucial for alleviating this problem.

Overcrowding in EDs throughout the country has caused problems in patient care and health care services. In Turkey, a significant portion of the patients who visit EDs do not require urgent care, and overcrowding caused by those patients with nonurgent conditions lead to decreases in the quality of service provided to patients who require urgent care. This shows that the concept of urgency and how to use EDs appropriately has not adequately been explained to the general population. Regardless of the level of education, patients lack an adequate perception of urgency, and the awareness of society regarding using health care services appropriately is inadequate. This problem is growing for both health care providers and patients.[2,3,12,16–18] In line with the results of this study, Chapman and Turnbull[19] found that increasing awareness regarding available health services for their primary care needs is necessary. In addition, increasing awareness about how to use available health services appropriately and developing self-care abilities could contribute to improving individuals’ health care-seeking behaviors.

The results of questionnaires administered to the patients indicated that the EDs were frequently used because patients preferred EDs, thought that their health conditions were urgent, wanted to receive quick care, and the EDs are open 24 hours a day, 7 days a week. Other studies conducted in Turkey have reported that the quality of ED care and ability to receive quick care affect patients’ decisions to use the ED for nonurgent care, which leads to higher costs and increases the workload of ED staff.[14,20] The results of this study also concur with those of Korczak et al.,[21] who found that convenience of the ED and access to all tests and investigations in the ED contribute to ED attendance.

In line with existing studies, this study revealed that some of the reasons patients use EDs include that EDs need no appointments, an inability to receive an appointment from outpatient clinics, and an inability to find alternative services outside of working hours. The use of EDs for nonurgent conditions contributes to ED overcrowding. These findings are consistent with other existing studies.[3,7,18,20,22–25] These results reflect those of Butun et al.,[5] who also found that improving outpatient clinic services, including developing the communication skills of health care staff, raising standards of care, and improving patient flow, could contribute to patients’ positive experiences with such clinics, thereby increasing patients’ use of these clinics for their health care needs rather than the ED.

We also found that people prefer to use EDs over GP clinics because GPs have limited interventions and equipment available. In line with this study, Butun et al.[5] and Malcolm et al.[26] found that patients had insufficient knowledge about GP clinics and how to use them appropriately. Improving primary health care services such as improving the physical conditions of buildings, medical equipment, and qualified staff should be considered as solutions for reducing nonurgent ED visits and, therefore, improving the quality of care.[1,27]

To the best of our knowledge, no other national-level studies on ED use have been conducted in Turkey. However, some studies were conducted by examining hospital records and obtaining information from patients, and inappropriate ED use was identified at different levels. This study is among those conducted in recent years to identify causes of the ED overcrowding, determine the reasons for nonurgent use of EDs, and develop solutions for reducing ED overcrowding in Turkey.


Although some studies have found overcrowding in and inappropriate use of EDs, research is limited on how to alleviate such problems. This should not be seen as a problem only for patients or staff. It also threatens all individuals by decreasing the quality of health care services, leading to dissatisfaction among patients and health care staff and increased health care costs. Emergency department overcrowding is a multifaceted issue that cannot be easily solved. Interventions need to be developed to reduce nonurgent ED visits, thereby promoting better continuity of care.[28] Many agents need to be involved in solving this problem, including related governmental health care institutions, researchers, ED physicians, GPs, ED nurses, and patients. Emergency department overcrowding should be perceived as an international problem, and initiatives for solutions should be implemented quickly.

Nonurgent ED visits and long waiting times in the ED contribute to ED overcrowding and prevent patients with urgent needs from receiving timely treatment in EDs. Insufficient physical infrastructure, understaffing, and high staff workload contribute to ED overcrowding. This study found that the reasons for nonurgent ED use include having problems receiving an appointment from outpatient clinics, patients being directed to the ED by their own GPs, ease of transportation, and patients’ perception that they could be examined in the ED in a short time. Emergency department overcrowding could be reduced by increasing the number of qualified staff, raising patients’ awareness regarding appropriate ED use, improving the appointment system for outpatient clinics, making primary health care services more effective, and using GP clinics appropriately.

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

All authors have contributed to the conception, design, analysis and interpretation of data, and writing of this study.


This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval of studies and informed consent

Ethical approval was obtained from Mardin Artuklu University Ethics Committee (date, December 14, 2021; reference, E-76272411-900-36850). In addition, the necessary permissions were obtained from Mardin Provincial Directorate of Health. Written informed consent was obtained from all participants.


The authors would like to acknowledge the patients who participated in this study and the hospital managerial teams for their help with participant recruitment.


1. Sempere-Selva T, Peiró S, Sendra-Pina P, Martínez-Espín C, López-Aguilera I. Inappropriate use of an accident and emergency department: magnitude, associated factors, and reasons—an approach with explicit criteria. Ann Emerg Med. 2001;37(6):568–579. doi:10.1067/mem.2001.113464
2. Sultanoğlu H, Gamsızkan Z, Cangür Ş. Investigation and solution proposals of repeating applications in patients admitted to the emergency in a year. J DU Health Sci Inst. 2021;11(1):50–55. doi:10.33631/duzcesbed.751317
3. Bozdağ Z. Operational Recommendations for Using Out of Purpose Emergency Services and Reducing Out-of-purpose Use: The Case of Çorum Province [master’s thesis]. Corum, Turkey: Hitit University, 2019.
4. Ersel M, Karcıoğlu Ö, Yanturalı S, Yürüktümen A, Sever M, Tunç MA. Emergency department utilization characteristics and evaluation for patient visit appropriateness from the patients’ and physicians’ point of view. Turk J Emerg Med. 2006;6(1):25–35.
5. Butun A, Lynn F, McGaughey J, McLaughlin K, Linden M. Exploring attendance at emergency departments for children with non-urgent conditions in Turkey: a qualitative study of parents and healthcare staff perspectives. Emerg Crit Care Med. 2022;2(2):50–60. doi:10.1097/ec9.0000000000000027
6. Montellier M, Delpech R, Mion M, Boué F, Metzger MH. Designing and describing an electronic referral system to facilitate direct hospital admissions. BMC Primary Care. 2022;23(1):57. doi:10.1186/s12875-022-01656-4
7. Butun A, Linden M, Lynn F, McGaughey J. Exploring parents’ reasons for attending the emergency department for children with minor illnesses: a mixed methods systematic review. Emerg Med J. 2019;36(1):39–46. doi:10.1136/emermed-2017-207118
8. Pines JM, Hilton JA, Weber EJ, et al. International perspectives on emergency department crowding. Academic Emerg Med. 2011;18(12):1358–1370. doi:10.1111/j.1553-2712.2011.01235.x
9. Khangura JK, Flodgren G, Perera R, Rowe BH, Shepperd S. Primary care professionals providing non-urgent care in hospital emergency departments. Cochrane Database Syst Rev. 2012;11:CD002097. doi:10.1002/14651858.CD002097.pub3
10. Gilligan P, Gupta V, Singh I, Winder S, O’Kelly P, Hegarty D. Why are we waiting? A study of the patients’ perspectives about their protracted stays in an emergency department. Irish Med J. 2007;100:627–630.
11. Timm NL, Ho ML, Luria JW. Pediatric emergency department overcrowding and impact on patient flow outcomes. Academic Emerg Med. 2008;15(9):832–837. doi:10.1111/j.1553-2712.2008.00224.x
12. Weiss SJ, Ernst AA, Derlet R, King R, Bair A, Nick TG. Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. Am J Emerg Med. 2005;23(3):288–294. doi:10.1016/j.ajem.2005.02.034
13. Moukarzel A, Michelet P, Durand AC, et al. Burnout syndrome among emergency department staff: prevalence and associated factors. Biomed Res Int. 2019;2019:6462472. doi:10.1155/2019/6462472
14. Söyük S, Kurtuluş SA. The evaluation of the problems’ emergency services from staff perspectives. Gümüşhane Uni J Health Sci. 2017;6(4):44–56.
15. Forero R, Hillman KM, McCarthy S, Fatovich DM, Joseph AP, Richardson DB. Access block and ED overcrowding. Emerg Med Australas. 2010;22(2):119–135. doi:10.1111/j.1742-6723.2010.01270.x
16. Rondeau KV, Francescutti LH. Emergency department overcrowding: the impact of resource scarcity on physician job satisfaction. J Healthc Manag. 2005;50(5):327–342.
17. Hwang U, Richardson LD, Morrison RS; Sonuyi TO. The effect of emergency department crowding on the management of pain in older adults with hip fracture. J Am Geriatr Soc. 2006;54(2):270–275. doi:10.1111/j.1532-5415.2005.00587.x
18. Payza U. An unsolvable public health problem; improper use of emergency servicesand patients’ views. Manisa Celal Bayar Uni J Inst Health Sci. 2020;7(3):251–256. doi:10.34087/cbusbed.590562
19. Chapman B, Turnbull T. Health professionals’ perceptions of inappropriate use of A&E services. Br J Nurs. 2016;25(9):476–483. doi:10.12968/bjon.2016.25.9.476
20. Şimşek P, Gürsoy A. Urgent problem of emergency departments: inappropriate use. J Anatolia Nurs Health Sci. 2015;18(4):312–317.
21. Korczak V, Yakubu K, Angell B, et al. Understanding patient preferences for emergency care for lower triage acuity presentations during GP hours: a qualitative study in Australia. BMC Health Serv Res. 2022;22(1):1442. doi:10.1186/s12913-022-08857-8
22. Ilhan B. Efficacy of Using NEDOCS (National Emergency Department Overcrowding Study) Score for Evaluation of Emergency Department Overcrowding. Ankara, Turkey: Hacettepe University Faculty of Medicine, 2016. Thesis of Emergency Medicine.
23. Köse A, Köse B, Öncü MR, Tuğrul F. Admission appropriateness and profile of the patients attended to a state hospital emergency department. Gaziantep Med J. 2011;2(17):57–62.
24. Aydın T, Aydın ŞA, Köksal Ö, Özdemir F, Kulaç S, Bulut M. Evaluation of features of patients attending the Emergency Department of Uludag University Medicine Faculty Hospital and emergency department practices. Akademik Acil Tıp Dergisi. 2010;9(4):163–168.
25. Butun A, Hemingway P. A qualitative systematic review of the reasons for parental attendance at the emergency department with children presenting with minor illness. Int Emerg Nurs. 2018;36:56–62. doi:10.1016/j.ienj.2017.07.002
26. Malcolm C, King E, France E, et al. Short stay hospital admissions for an acutely unwell child: a qualitative study of outcomes that matter to parents and professionals. PloS ONE. 2022;17(12):e0278777. doi:10.1371/journal.pone.0278777
27. Salman A. Investigation of Recurrent Applications to Emergency Departments. Gaziantep, Turkey: Faculty of Medicine, Gaziantep University, 2019. Specialty Thesis.
28. Poku BA, Hemingway P. Reducing repeat paediatric emergency department attendance for non-urgent care: a systematic review of the effectiveness of interventions. Emerg Med J. 2019;36(7):435–442. doi:10.1136/emermed-2018-207536

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