BackgroundEmergency Department (ED) overcrowding adversely affects patients’ health, accessibility, and quality of healthcare systems for communities. Several studies have addressed this issue. This study aimed to conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals.MethodsOriginal research articles on crowding of emergencies at hospitals published from 1st January 2007, and 1st August 2018 were utilized. Relevant studies from the PubMed and EMBASE databases were assessed using suitable keywords. Two reviewers independently screened the titles, abstracts and the methodological validity of the records using data extraction format before their inclusion in the final review. Discussions with the senior faculty member were used to resolve any disagreements among the reviewers during the assessment phase.ResultsOut of the total 117 articles in the final record, we excluded 11 of them because of poor quality. Thus, this systematic review synthesized the reports of 106 original articles. Overall 14, 55 and 29 of the reviewed refer to causes, effects, and solutions of ED crowding, respectively. The review also included four articles on both causes and effects and another four on causes and solutions. Multiple individual patients and healthcare system related challenges, experiences and responses to crowding and its consequences are comprehensively synthesized.ConclusionED overcrowding is a multi-facet issue which affects by patient-related factors and emergency service delivery. Crowding of the EDs adversely affected individual patients, healthcare delivery systems and communities. The identified issues concern organizational managers, leadership, and operational level actions to reduce crowding and improve emergency healthcare outcomes efficiently.

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Background: Hospital Information System (HIS) is implemented to provide high-quality patient care. The aim of this study is to identify significant dimensional factors that influence the hospital decision in adopting the HIS. Methods: This study designs the initial integrated model by taking the three main dimensions in adopting HIS technology. Accordingly, DEMATEL was utilized to test the strength of interdependencies among the dimensions and variables. Then ANP approach is adapted to determining how the factors are weighted and prioritized by professionals and main users working in the Iranian public hospitals, involved with the HIS system. Results: The results indicated that "Perceived Technical Competence" is a key factor in the Human dimension. The respondents also believed that "Relative Advantage," "Compatibility" and "Security Concern" of Technology dimension should be further assessed in relation to other factors. With respect to Organization dimension, "Top Management Support" and "Vendor Support" are considered more important than others. Conclusion: Applying the TOE and HOT-fit models as the pillar of our developed model with significant findings add to the growing literature on the factors associated with the adoption of HIS and also shed some light for managers of public hospitals in Iran to successfully adopt the HIS.