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Review
. 2020:54:66.
doi: 10.11606/s1518-8787.2020054002342. Epub 2020 Jul 3.

Interventions in overcrowding of emergency departments: an overview of systematic reviews

Roberto José Bittencourt  1 , Angelo de Medeiros Stevanato  1 , Carolina Thomé N M Bragança  1 , Leila Bernarda Donato Gottems  1 , Gisele O'Dwyer  2
Affiliations
Review

Interventions in overcrowding of emergency departments: an overview of systematic reviews

Roberto José Bittencourt et al. Rev Saude Publica. 2020.

Abstract

OBJECTIVE To present an overview of systematic reviews on throughput interventions to solve the overcrowding of emergency departments. METHODS Electronic searches for reviews published between 2007 and 2018 were made on PubMed, Cochrane Library, EMBASE, Health Systems Evidence, CINAHL, SciELO, LILACS, Google Scholar and the CAPES periodicals portal. Data of the included studies was extracted into a pre-formatted sheet and their methodological quality was assessed using AMSTAR 2 tool. Eventually, 15 systematic reviews were included for the narrative synthesis. RESULTS The interventions were grouped into four categories: (1) strengthening of the triage service; (2) strengthening of the ED's team; (3) creation of new care zones; (4) change in ED's work processes. All studies observed positive effect on patient's length of stay, expect for one, which had positive effect on other indicators. According to AMSTAR 2 criteria, eight revisions were considered of high or moderate methodological quality and seven, low or critically low quality. There was a clear improvement in the quality of the studies, with an improvement in focus and methodology after two decades of systematic studies on the subject. CONCLUSIONS Despite some limitations, the evidence presented on this overview can be considered the cutting edge of current scientific knowledge on the topic.

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Conflict of interest statement

Conflict of Interest: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1. Prisma flow diagram
Figure 3
Figure 3. Interventions identified in all the studies
Figure 2
Figure 2. AMSTAR 2 assessment results for each included review.
See this image and copyright information in PMC

References

    1. 1. Pines JM, Hilton JA, Weber EJ, Alemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Acad Emerg Med. 2018(12):1358-70. 10.1111/j.1553-2712.2011.01235.x - DOI - PubMed
    2. Pines JM, Hilton JA, Weber EJ, Alemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Acad Emerg Med. 2018;(12):1358–1370. doi: 10.1111/j.1553-2712.2011.01235.x. - DOI - PubMed
    1. 2. Berchet C. Emergency care services: trends, drivers and interventions to manage the demand. Paris: Organisation for Economic Cooperation and Development (OECD); 2015.
    2. Berchet C. Emergency care services: trends, drivers and interventions to manage the demand. Paris: Organisation for Economic Cooperation and Development (OECD); 2015.
    1. 3. Hsia RY, Kellermann AL, Shen YC. Factors associated with closures of emergency departments in the United States. JAMA. 2011;305(19):1978-85. 10.1001/jama.2011.620 - DOI - PMC - PubMed
    2. Hsia RY, Kellermann AL, Shen YC. Factors associated with closures of emergency departments in the United States. JAMA. 2011;305(19):1978–1985. doi: 10.1001/jama.2011.620. - DOI - PMC - PubMed
    1. 4. Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J. 2003;20(5):406-9. 10.1136/emj.20.5.406 - DOI - PMC - PubMed
    2. Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J. 2003;20(5):406–409. doi: 10.1136/emj.20.5.406. - DOI - PMC - PubMed
    1. 5. American College of Emergency Physicians -ACEP. Policy statements. Ann Emerg Med. 2013;61(6):602-3. 10.1016/j.annemergmed.2013.02.012 - DOI
    2. American College of Emergency Physicians -ACEP Policy statements. Ann Emerg Med. 2013;61(6):602–603. doi: 10.1016/j.annemergmed.2013.02.012. - DOI