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ABSTRACT Overcrowding in the Emergency Department (ED) is a serious problem affecting service quality and patient safety, with access block as one of the main contributing factors. Access block occurs when patients who require hospitalization cannot be immediately transferred to inpatient wards, resulting in patient accumulation in the ED. This study aimed to analyze factors associated with overcrowding among access block patients in the Emergency Department of RSUD X.= This study employed a quantitative observational analytic design with a prospective cross-sectional approach. Data were collected through direct observation of service conditions in the Emergency Department during December 2025 with a total sample of 430 patients. Variables included access block, overcrowding level measured using the National Emergency Department Overcrowding Score (NEDOCS), human resources, facilities and infrastructure, and patient output. Data were analyzed using univariate and bivariate analysis with the Chi-Square test. The results showed that most Emergency Department conditions experienced overcrowding (88.4%), and 45.6% of patients experienced access block. There was a significant relationship between access block and overcrowding (p = 0.008), human resources and overcrowding (p 0.001), facilities and infrastructure and overcrowding (p = 0.004), and patient output and overcrowding (p = 0.008). Access block and internal Emergency Department factors are significantly associated with overcrowding at RSUD X. Improvements in patient flow management, optimization of human resources, and enhancement of facilities and infrastructure are needed to reduce overcrowding in the Emergency Department. Keywords : Access Block, Overcrowding, Emergency Department, NEDOCS. ABSTRAK Overcrowding di Instalasi Gawat Darurat (IGD) merupakan permasalahan serius yang berdampak pada mutu pelayanan dan keselamatan pasien. Salah satu penyebab utama overcrowding adalah access block, yaitu kondisi ketika pasien yang telah diputuskan untuk rawat inap tidak dapat segera dipindahkan ke ruang perawatan sehingga terjadi penumpukan pasien di IGD. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berhubungan dengan kejadian overcrowding pada pasien access block di Instalasi Gawat Darurat RSUD X. Penelitian ini menggunakan desain kuantitatif observasional analitik dengan pendekatan cross sectional prospektif. Pengumpulan data dilakukan melalui observasi langsung pada setiap momen pelayanan di Instalasi Gawat Darurat RSUD X selama bulan Desember 2025 dengan jumlah sampel sebanyak 430 pasien. Variabel penelitian meliputi kejadian access block, tingkat overcrowding berdasarkan National Emergency Department Overcrowding Score (NEDOCS), kondisi sumber daya manusia (SDM), sarana dan prasarana, serta output pasien. Analisis data dilakukan secara univariat dan bivariat menggunakan uji Chi-Square. Hasil penelitian menunjukkan bahwa sebagian besar kondisi IGD mengalami overcrowding (88,4%) dan hampir setengah pasien mengalami access block (45,6%). Terdapat hubungan yang signifikan antara access block dengan overcrowding (p = 0,008), antara kondisi SDM dengan overcrowding (p 0,001), antara sarana dan prasarana dengan overcrowding (p = 0,004), serta antara output pasien dengan overcrowding (p = 0,008). Access block dan faktor internal IGD berhubungan signifikan dengan terjadinya overcrowding di Instalasi Gawat Darurat RSUD X. Diperlukan perbaikan manajemen alur pasien, optimalisasi sumber daya manusia, serta peningkatan sarana dan prasarana untuk menurunkan kejadian overcrowding di Instalasi Gawat Darurat. Kata Kunci: Access Block, Overcrowding, Instalasi Gawat Darurat, NEDOCS.