Abstract: Rationale for the study- Emergency department fulfills a critical role in the community, saving many lives each year, providing front line care, preventing the escalation of potentially critical ailments and directing flow of patients to targeted and continuing treatment. Delivering this role requires comprehensive monitoring and reporting processes that define outcomes, record data and measure success in the performance of emergency health care but crowding in emergency department became a major barrier to receiving timely emergency care. The main objective is to describe in details the complete process of developing a group of strategic key performance indicators to monitor measure and improve the performance of a tertiary care hospital. This project aimed at standardizing KPIs to provide higher management with information and support evidence for strategic decision making and to set benchmark for provided services. Key words: KPI (Key Performance Indicators), ER (Emergency Room), Throughput, Golden Hour