# gEDWIN: a simple and practical index for real-time monitoring of emergency department crowding

## TL;DR

This paper introduces gEDWIN, a simplified and practical index for real-time monitoring of emergency department crowding, offering an improvement over the traditional EDWIN.

## Contribution

The paper introduces gEDWIN, a simpler and more practical alternative to the traditional EDWIN for real-time ED crowding monitoring.

## Key findings

- gEDWIN performed well in simulations and real data from Australian hospitals.
- gEDWIN offers performance comparable to EDWIN but with greater simplicity and practicality.
- gEDWIN is suitable for real-time monitoring across different hospital settings.

## Abstract

To propose a generalised Emergency Department Work Index (gEDWIN) as an alternative to the traditional Emergency Department Work Index (EDWIN), which is impractical for real-time warning due to its complexity and data requirements. gEDWIN offers a more efficient, adaptable, and scalable approach for monitoring emergency department (ED) crowding in real time.

The relationships between various emergency department crowding indices—including Bed Ratio (BR) or Occupancy Rate (OR), Acuity Ratio (AR), and EDWIN—are thoroughly investigated. By leveraging these relationships, we propose a new gEDWIN. Currently, BR is considered one of the most effective ED crowding indices. A simulation study was performed to validate the effectiveness of the gEDWIN. A comprehensive comparison between BR (or OR), gEDWIN, and the traditional EDWIN was conducted to evaluate their performance using real Emergency Department data from three hospitals (two large and one medium-sized) in Australia.

The results demonstrated that gEDWIN performed well. Despite the lack of standardised measurement tools, gEDWIN provided a promising metric for ED crowding and shows potential for broader applicability across different ED settings. The comparative evaluation indicated that gEDWIN provides performance comparable to EDWIN, while offering a simpler and more practical approach to estimating ED occupancy rate. In addition, gEDWIN distinguishes itself with its simplicity and practicality, allowing for real-time monitoring of ED crowding. Its design makes it suitable for use across various hospital settings, regardless of their size or physician volume.

gEDWIN’s simplicity and practicality suggest it may be a valuable tool for real-time monitoring of ED crowding across hospitals of varying sizes and physician volumes. However, its broader adoption across diverse healthcare environments will require further validation in varied clinical contexts.

Not applicable.

The online version contains supplementary material available at 10.1186/s12873-025-01397-4.