Purpose <p>To propose a generalised Emergency Department Work Index (gEDWIN) as an alternative to the traditional Emergency Department Work Index (EDWIN), which is impractical for real-time warning due to its complexity and data requirements. gEDWIN offers a more efficient, adaptable, and scalable approach for monitoring emergency department (ED) crowding in real time.</p> Methods <p>The relationships between various emergency department crowding indices—including Bed Ratio (BR) or Occupancy Rate (OR), Acuity Ratio (AR), and EDWIN—are thoroughly investigated. By leveraging these relationships, we propose a new gEDWIN. Currently, BR is considered one of the most effective ED crowding indices. A simulation study was performed to validate the effectiveness of the gEDWIN. A comprehensive comparison between BR (or OR), gEDWIN, and the traditional EDWIN was conducted to evaluate their performance using real Emergency Department data from three hospitals (two large and one medium-sized) in Australia.</p> Results <p>The results demonstrated that gEDWIN performed well. Despite the lack of standardised measurement tools, gEDWIN provided a promising metric for ED crowding and shows potential for broader applicability across different ED settings. The comparative evaluation indicated that gEDWIN provides performance comparable to EDWIN, while offering a simpler and more practical approach to estimating ED occupancy rate. In addition, gEDWIN distinguishes itself with its simplicity and practicality, allowing for real-time monitoring of ED crowding. Its design makes it suitable for use across various hospital settings, regardless of their size or physician volume.</p> Conclusion <p>gEDWIN’s simplicity and practicality suggest it may be a valuable tool for real-time monitoring of ED crowding across hospitals of varying sizes and physician volumes. However, its broader adoption across diverse healthcare environments will require further validation in varied clinical contexts.</p> Clinical trial number <p>Not applicable.</p>