{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T17:45:59Z","timestamp":1791740759743,"version":"4.3.4"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Serv Manage Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency Department (ED) overcrowding is a global systemic challenge driven by an imbalance between healthcare demand and resource availability. This study evaluates a multifaceted, organization-wide intervention at an Italian teaching hospital by focusing on throughput and output factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A quasi-experimental, pre-post design analysed 100% of the available population data (N = 199354 visits) from 2019 to 2024. A \u201cDigital Twin\u201d simulation identified boarding as the primary bottleneck, consuming 47% of medical resources. Interventions included a \u201cDischarge Decalogue,\u201d digitalization of community care pathways (ADI\/CAVS), and nursing protocols. Statistical significance for patient satisfaction (N = 1840) was assessed via t-tests (95% CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite a 23.6% increase in total ED volume and a 37.8% surge in high-complexity presentations (Red Codes), interventions optimized outflow. The ALOS for complex discharges decreased for both CAVS (\u221224.6%) and ADI (\u221222.6%). Throughput protocols reduced chest pain response times by 27.7%. Satisfaction scores improved accordingly, particularly within the information domain (p &lt; 0.001; 95\/% CI [0.22, 0.38]). While overall waiting times fell by 17.8%, boarding times increased: this was driven by clinical complexity and a deliberate institutional policy to mitigate medical boarding within surgical units. This strategic prioritization was maintained to preserve elective surgical capacity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A systems-based approach prioritizing output optimization and hospital-territory integration demonstrates superior efficacy compared to traditional input-reduction strategies. This data-driven model provides a scalable framework to strengthen clinical governance and enhance patient experience within resource-constrained environments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09514848261490128","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:59:33Z","timestamp":1791478773000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital-wide interventions to reduce emergency department overcrowding: Data-driven strategies and clinical governance at an Italian teaching hospital"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9198-8533","authenticated-orcid":false,"given":"Roberta","family":"Bellini","sequence":"first","affiliation":[{"name":"Strategic Development and Organizational Innovation Department, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3401-0756","authenticated-orcid":false,"given":"Riccardo","family":"Boverio","sequence":"additional","affiliation":[{"name":"Strategic Development and Organizational Innovation Department, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3235-0327","authenticated-orcid":false,"given":"Cristian","family":"Zanelli","sequence":"additional","affiliation":[{"name":"Strategic Development and Organizational Innovation Department, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ingala","sequence":"additional","affiliation":[{"name":"Strategic Development and Organizational Innovation Department, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2927-7204","authenticated-orcid":false,"given":"Valentina","family":"Lenti","sequence":"additional","affiliation":[{"name":"Strategic Development and Organizational Innovation Department, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9422-0035","authenticated-orcid":false,"given":"Tatiana","family":"Maan","sequence":"additional","affiliation":[{"name":"Strategic Development and Organizational Innovation Department, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1540-6673","authenticated-orcid":false,"given":"Massimo","family":"Corona","sequence":"additional","affiliation":[{"name":"Strategic Development and Organizational Innovation Department, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.12927\/hcq.2007.19312"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2004.018002"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2004.019042"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1197\/j.aem.2006.10.104"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2003.302"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10091625"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.4081\/ecj.2010.2.25"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-019-02267-1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.03.033"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.07.021"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2006.tb00204.x"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2014.11.004"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2016-205886"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203316"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00295.x"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-023-03239-2"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.2196\/78073"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-10725-6"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-10806-6"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12020279"},{"key":"e_1_3_3_22_2","doi-asserted-by":"crossref","unstructured":"Yusrawati Y Muhardi M. 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