Akademik Veri Yönetim Sistemi
Journal of Emergency Medicine, cilt.81, ss.68-77, 2026 (SCI-Expanded, Scopus)
Background Emergency department (ED) crowding is a major operational problem driven by access block. Transition units (TUs) have been proposed to mitigate boarding delays, but their quantitative impact remains insufficiently characterized. Objectives To evaluate the effect of implementing medical and surgical TUs on ED crowding, measured by the National Emergency Department Overcrowding Scale (NEDOCS). Methods This single-center prospective study evaluated crowding in a tertiary academic ED before and after TU implementation. NEDOCS scores were prospectively measured 6 times daily between April 23 and May 31, 2025, when both medical and surgical TUs were fully operational. Data from identical calendar periods in 2021 (pre-TU) and 2023 (medical TU only) served as comparators. The primary outcome was the NEDOCS score; secondary outcomes were NEDOCS parameters and categorical level distributions. Results The median NEDOCS score in 2025 was 85.6 (IQR 66.2–117.0), significantly lower than 2021 (137 [IQR 114.0–173.0]) and 2023 (132 [IQR 108.0–181.0]) (both p < 0.001). Overcrowded or worse conditions (Levels IV–VI) decreased from 81.5% (2021) and 80.6% (2023) to 38.4% (2025) ( p < 0.001). Boarding numbers and longest boarding times also fell significantly, whereas overall patient inflow to the ED remained comparable across years. Conclusions Implementation of dual TUs was associated with substantial reductions in ED crowding severity, as reflected by lower NEDOCS scores and improved operational metrics. Expanding TU capacity across specialties is an effective structural strategy to relieve access block in high-volume EDs.