Authors: Emtenan M. Bukhari , Mohammed A. Almohammadi , Mona S. Buraysali , Ghalyah T. Kerdawi , Abdullah A. Aljazaeri , Hussam A. Alzahrani , Omar M. Alsuwat , Wefag J. Sawadi , Mohammed A. Albokhari

Abstract

Background: This systematic review synthesizes evidence on the prevalence, causes, and associated factors of non-urgent emergency department (ED) visits in Saudi Arabia, which contribute to overcrowding, increased costs, and delays in urgent care.
Methods: 
We conducted a systematic review following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched from inception to the search date. We included observational studies from Saudi Arabia reporting prevalence, reasons, or factors associated with non-urgent ED visits. Three reviewers screened titles/abstracts and assessed full texts. Two reviewers extracted data using a standardized form and assessed study quality using Joanna Briggs Institute critical appraisal tools. Because of heterogeneity across definitions and outcomes, we synthesized findings narratively.
Results:
Eleven studies published between 2002 and 2024 were included (total sample size 30,684). Non-urgent ED visit prevalence ranged from 20.7% to 82.4% (mean 49.75%). Most studies defined non-urgent visits using the Canadian Triage and Acuity Scale levels IV–V. Younger age groups were most frequently associated with non-urgent ED use. Commonly reported drivers included dissatisfaction with primary healthcare services, limited appointment availability or working hours, and perceived faster or better ED care. Risk of bias was low to moderate.
Conclusions:
Non-urgent ED visits represent a substantial burden in Saudi Arabia. Improving access to high-quality primary healthcare, strengthening triage and referral processes, and increasing public awareness may reduce non-urgent ED use and preserve ED capacity for urgent care.

Keywords: Emergency service, hospital, primary health care, access to primary care, triage, Saudi Arabia.