Triage is the first process of assessment and prioritization of all patients who present to emergency departments (EDs) into categories according to their condition and level of urgency. In this study, a systematic review of the literature on the effectiveness of triage systems was conducted in Saudi Arabia. Following PRISMA guidelines, six large databases were searched for relevant articles published between 2003 and 2023. Three authors reviewed the titles, abstracts, and full texts. The databases were searched using the following keywords: triage systems, CTAS, emergency department overcrowding, non-urgent or inappropriate visits to the ED, ED overutilization, and triage and ED overcrowding in the Middle East. A total of 1,051 articles were identified, of which 245 met our inclusion criteria. From the findings of these studies, in relation to the factors that reduce triage efficacy in the Middle East and specifically in Saudi Arabia, it can be argued that there is a need for more studies and solutions to address these issues. Patients are in need of health education, and alternative solutions must be considered to address the high percentage of non-urgent visits to the ED. Emergency department triage is the first screening step that sorts patients in emergency situations by categorizing their urgency levels to prioritize patients for evaluation and treatment. Because the ED is an integral hospital department and a complicated, fast-paced environment, ED healthcare services have evolved to be delivered through effective triage systems to reduce waiting times and overcrowding.