• Mohammad Hossein Mehrolhassani, Anahita Behzadi, and Elaheh Asadipour.
• Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
• Scand J Trauma Resus. 2025 Jan 30; 33 (1): 1515.

BackgroundOne way to measure emergency department (ED) performance is using key performance indicators (KPIs). Thus, identifying reliable KPIs can be critical in appraising ED performance. This study aims to introduce and classify the KPIs related to ED in simulations through the Balanced Scorecard (BSC) framework.MethodThis scoping review was performed in 2024 without any time limitation based on the Arksey and O'Malley framework. The electronic databases of PubMed, Scopus, Web of Science, EMBASE, MathSciNet, Google Scholar, and Persian databases such as IranDoc, MagIran, and SID were searched. The winter simulation conference was also investigated through manual searching. Furthermore, the screening process of included studies was based on the PRISMA reporting checklist. The data were analyzed by content analysis deductively and inductively. The extracted KPIs were coded as analysis units and transferred to the MAXQDA2020 software. Then, the KPIs were integrated and organized based on similarity. Moreover, the two authors discussed disagreements to reach a consensus on the final codes. The final KPIs classification was carried out based on the BSC framework to achieve a holistic view. The BSC is a managerial tool for evaluating organizations' performance via different dimensions. It contains four main dimensions: Customer, Financial, Growth and infrastructure, and Internal Processes. In addition, the management (vision, objectives, and strategies) has been positioned at the heart of the framework.ResultInitially, 4257 articles were retrieved, and 125 articles were included after screening. Finally, 109 KPIs were extracted and classified into five categories. They include input, processing time, cost and revenue, utilization and productivity, and output indicators. Then, each category of KPIs was positioned in the BSC framework dimensions. Additionally, the findings showed that most indicators were related to the time of process indicators.ConclusionsThe study findings have collected a comprehensive set of KPIs to measure ED performance in simulations. These results can assist policymakers, managers, and researchers in measuring ED performance and help improve ED performance through a holistic view.© 2025. The Author(s).

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