Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Aug;31(8):789-804.
doi: 10.1111/acem.14946. Epub 2024 Jun 3.

Interventions to improve emergency department throughput and care delivery indicators: A systematic review and meta-analysis

Elias Youssef  1 , Roshanak Benabbas  1 , Brittany Choe  1 , Donald Doukas  1 , Hope A Taitt  1 , Rajesh Verma  1 , Shahriar Zehtabchi  1
Affiliations
Free article
Meta-Analysis

Interventions to improve emergency department throughput and care delivery indicators: A systematic review and meta-analysis

Elias Youssef et al. Acad Emerg Med. 2024 Aug.
Free article

Abstract

Background: Emergency department (ED) crowding has repercussions on acute care, contributing to prolonged wait times, length of stay, and left without being seen (LWBS). These indicators are regarded as systemic shortcomings, reflecting a failure to provide equitable and accessible acute care. The objective was to evaluate the effectiveness of interventions aimed at improving ED care delivery indicators.

Methods: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing ED interventions aimed at reducing key metrics of time to provider (TTP), time to disposition (TTD), and LWBS. We excluded disease-specific trials (e.g., stroke). We used Cochrane's revised tool to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations to rate the quality of evidence. The meta-analysis was performed using a random-effects model and Cochrane Q test for heterogeneity. Data were summarized as means (±SD) for continuous variables and risk ratios (RR) with 95% confidence intervals (CIs).

Results: We searched MEDLINE, EMBASE, and other major databases. A total of 1850 references were scanned and 20 RCTs were selected for inclusion. The trials reported at least one of the three outcomes of TTD, TTP, or LWBS. Most interventions focused on triage liaison physician and point-of-care (POC) testing. Others included upfront expedited workup (ordering tests before full evaluation by a provider), scribes, triage kiosks, and sending notifications to consultants or residents. POC testing decreased TTD by an average of 5-96 min (high heterogeneity) but slightly increased TTP by a mean difference of 2 min (95% CI 0.6-4 min). Utilizing a triage liaison physician reduced TTD by 28 min (95% CI 19-37 min; moderate-quality evidence) and was more effective in reducing LWBS than routine triage (RR 0.76, 95% CI 0.66-0.88; moderate quality).

Conclusions: Operational strategies such as POC testing and triage liaison physicians could mitigate the impact of ED crowding and appear to be effective. The current evidence supports these strategies when tailored to the appropriate practice environment.

Keywords: emergency department; hospital emergency service; left without being seen; length of stay; time to treatment; wait time.

PubMed Disclaimer

References

REFERENCES

    1. Affleck A, Parks P, Drummond A, Rowe BH, Ovens HJ. Emergency department overcrowding and access block. CJEM. 2013;15(6):359‐384.
    1. Javidan AP, Hansen K, Higginson I, Jones P, Lang E, IFEM Task Force on Emergency Department Crowding, Access Block. The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary. CJEM. 2021;23(1):26‐28.
    1. Rathlev N, Schafermeyer R, Zwemer F, Schull M, Asplin BR, Society for Academic Emergency Medicine, Emergency Department Crowding Task Force. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16(1):1‐10.
    1. Emergency Medicine Practice Committee. Emergency Department Crowding: High Impact Solutions. American College of Emergency Physicians. May 2016. Accessed February 5, 2024. https://www.acep.org/siteassets/sites/acep/media/crowding/empc_crowding‐...
    1. Jo S, Kim K, Lee JH, et al. Emergency department crowding is associated with 28‐day mortality in community‐acquired pneumonia patients. J Infect. 2012;64(3):268‐275.

LinkOut - more resources