Obstacles and Challenges Affecting Quality Indicators in a Complex Tertiary Emergency Center.

Introduction: Hospital performance is significantly affected by external factors (political and economic) rather than internal factors (effectiveness and efficiency). Emergency department (ED) overcrowding is a significant issue for emergency care services globally, characterized by a rising number of visits and persistent unsolved issues, resulting in increased challenges faced by ED staff and decreased patient satisfaction. This study aimed to explore the obstacles and challenges that cause variation in ED quality indicators (QIs) based on five domains: infrastructure, population, workflow, workforce, and administration.