Interventions to reduce wait times in emergency departments in Canadian hospitals: A scoping review

Abstract

Objectives: Prolonged wait times in Canada's Emergency Departments (EDs) adversely impact patients, hospital staff, and the healthcare system. Despite the growing literature on ED wait times in Canada, our understanding of what strategies work to reduce wait time remains sporadic due to the absence of a current, comprehensive mapping of the interventions implemented within EDs. This scoping review aims to address this gap and map ED interventions in Canada, which may be useful for policymakers and healthcare professionals to make evidence-informed decisions.

Study design: Scoping Review.

Methods: Utilizing Arksey and O'Malley's methodological framework, we summarized peer-reviewed articles on interventions in Canadian EDs from January 2010 to May 2024. To categorize and interpret the diverse interventions, we conducted a narrative synthesis using Braun and Clark's thematic analysis method.

Results: We identified 21 articles, predominantly focusing on Ontario (n = 16). Most studies utilized retrospective evaluations (n = 16), followed by cluster randomized trials (n = 2), quasi-experimental design (n = 1), prospective survey (n = 1), and before-after design (n = 1). Nearly all were in high-volume urban EDs, with one in a rural setting. Interventions were categorized into five themes: Alternative Location, Financial Incentives, Health Workforce Enhancement, Process Improvement, and Integrated Intervention. While alternative ED locations, health workforce enhancement, and integrated approaches showed promise in reducing ED wait times, financial incentives and process improvement initiatives showed mixed results.

Conclusions: The reviewed interventions focused on strengthening ED operational efficiencies, but sustainable wait time reduction necessitates multifaceted, context-specific approach. Future research should consider broader health system challenges and ED contextual issues.

Keywords: Canadian healthcare system; ED interventions; Emergency Department (ED) wait times; Health policy and practice; Health system efficiency; Scoping review.