Abstract

Non-urgent emergency department (ED) use and primary healthcare (PHC) bypass result in crowding in Saudi Arabia EDs. This review aimed to summarize determinants and outcomes to inform management strategies. Electronic databases were searched from 2014 to 2025 for observational Saudi studies evaluating non-urgent Canadian Triage and Acuity Scale (CTAS) 4 and 5 ED visits or PHC bypass. Eligible designs were retrospective
analyses and cross-sectional surveys. A total of 6 original articles were included in this systematic review, including two chart reviews and four surveys in tertiary and regional hospitals. Non-urgent cases burden was high: CTAS 4 and 5 formed 61.4% of patients in the largest study; 78.5% of non-life-threatening attendees were triaged non-urgent. Common motives include routine investigations, medication refills, and mild upper respiratory symptoms. Determinants include convenience, appointment unavailability, limited PHC diagnostics, and low awareness of PHC services. Most visits ended with prescriptions and basic laboratory tests; radiology use was not needed in most cases, as well as admissions and specialty referrals. Non-urgent ED visits
are mainly affected by access and knowledge gaps and require high acuity interventions. Hence, ED demand can be decreased by expanding after-hours PHC capacity, offering rapid appointments, diagnostics, and implementing electronic referral.

Key words: Non-urgent emergency department use, primary healthcare bypass, CTAS, Saudi Arabia, electronic referral, urgent care.