Submission ID 118286
| Issue/Objective | Globally, prolonged emergency department (ED) wait times pose a significant challenge to healthcare systems. Evidence suggests that in-hospital operational issues and broader health system problems shape ED wait times. Yet existing literature often underemphasizes the out-of-hospital determinants of ED wait times and does not fully elucidate the complex interrelationships among them, which may result in the fragmented understanding of ED wait times. The objective of this study is to introduce a novel Syndemic framework that examines how multiple, interconnected health and social problems interact under specific contexts, for conceptualizing ED wait times as a multifaceted phenomenon. |
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| Methodology/Approach | We conducted a narrative review of health science databases (2000-2024) to identify 20 relevant articles based on established inclusion criteria. We analyzed key conceptual frameworks, synthesized their strengths and limitations, and applied thematic analysis to develop a novel framework. |
| Results | Five existing frameworks were identified: 1) the Input-Throughput-Output framework, which examines ED operational bottlenecks; 2) Lean Process Improvement framework that focuses on hospital-wide efficiency; 3) ED Wait Time-Admission Rate framework links wait times to hospital admissions; 4) Perception-Expectation framework explores patient experiences of ED wait time; and 5) ED Patient Flow framework identifies critical points of patients navigating in the ED. While each framework contributes valuable insights, they rarely focus on understanding the interrelated systemic and contextual drivers of ED wait times. To address this gap, the Syndemic framework is offered to situate ED wait times at the intersection of ED utilization, operational barriers, and external structural factors, such as access to primary care shortage, workforce limitations, and financing constraints. This novel framework shifts the lens from linear, department-level fixes toward a systems-wide approach that recognizes the synergistic impacts of multiple determinants. |
| Discussion/Conclusion | Reducing ED wait times requires a comprehensive understanding that considers the synergistic effects of various determinants. Our Syndemic Framework offers a globally relevant lens for navigating these complexities and designing structural solutions. While developed in the Canadian context, the framework is adaptable and transferable to other health systems facing challenges related to access, equity, and resources. |
| Presenters and affiliations | Dipika Shankar Bhattacharyya University of Waterloo Elena Neiterman University of Waterloo Zahid Butt University of Waterloo |
