THE IMPACT OF THE COMMAND CENTER ON EMERGENCY DEPARTMENT PATIENT FLOW AND LENGTH OF STAY DURING HAJJ IN MAKKAH

Abstract

Background: The Hajj season observes one of the largest mass gatherings globally, with millions of pilgrims from countries all over the world performing the rites in a limited space and time. One of the important targets of intervention to streamline healthcare during Hajj is length of stay, with efforts centered on maximizing efficiency to minimize the strain on healthcare capacity.

Methods: This study utilized a quasi-experimental, before–after design with non-equivalent time windows, evaluating the effect of the use of a Command Center (CC) led by the “Tiger Team,” on emergency department (ED) performance across eight hospitals in the Makkah Health Cluster.

Results: Our findings show that real-time command-center operations, workload redistribution, and heat-risk mitigation significantly enhanced emergency-department efficiency and patient flow during Hajj. Patient satisfaction (PXMP) improved across Emergency Departments from 65.75 in June 2024 (n=711) to 74.43 in June 2025 (n=334; Δ=+8.68), with the largest gains in arrival (+11.91) and personal Issues (+8.50), paralleling increases in overall care rating (+7.88) and likelihood to recommend (+8.20). Conclusions: Our findings show significant improvements in patient flow, timeliness, and satisfaction, indicating that having a coordinated, real-time system to oversee processes can improve efficiency in response in mass-gathering contexts.