Date of Conferral

11-10-2025

Date of Award

November 2025

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Kourtney Nieves

Abstract

Emergency department (ED) overcrowding has become an increasingly critical issue for the healthcare system of Puerto Rico, resulting in delayed care and increased patient morbidity, among other challenges faced by hospital leaders and administrators. This paper explores evidence-based strategies tailored to the Puerto Rican healthcare context to alleviate ED overcrowding. An integrative review of literature published between 2020 and 2025 was conducted. For this review, 15 articles were selected and appraised using the Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals. The strategies gleaned from the literature comprised six themes and 21 subthemes, centered on two major outcomes: reducing wait times and reducing ED overcrowding. These strategies include patient education to redirect patients with non-emergent cases to alternate urgent care locations, building and establishing a specialized team to address overcrowding, and optimizing the hospital’s operations, such as improving patient flow. The results show that the efficiency and sustainability of the ED depends on a system-wide integration (i.e., triage redesign, diagnostic acceleration, capacity optimization, and data-driven management). Recommendations for professional practice focus on the implementation of a collaborative triage redesign, integrate point-of-care testing (POCT), adopt predictive data tools, and set quality and safety mechanisms into routine ED operations. The implications for social change include promoting equitable access to care, enhancing workforce resilience, and fostering the public’s trust through transparency and adaptability. Despite limitations, the review proposes transforming the EDs in Puerto Rico into responsive, data-driven ecosystems to reduce wait times and overcrowding.

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