Throughput interventions to reduce emergency department crowding: A systematic review

Area of Science:

• Emergency medicine
• Healthcare operations research
• Health services research

Background:

• Emergency department (ED) throughput is critical for efficient patient care.
• Operational interventions are frequently implemented to improve ED efficiency.

Purpose of the Study:

• To systematically review the impact of ED throughput strategies on length of stay and left without being seen rates.
• To identify effective interventions for enhancing ED operational efficiency.

Main Methods:

• Systematic literature search of Medline, Embase, CINAHL, and Cochrane Central Register of Controlled Trials.
• Screening, quality assessment, and risk of bias evaluation by two independent reviewers.
• Meta-analysis of eligible studies following PRISMA guidelines.

Main Results:

• 94 studies met inclusion criteria; most were observational.
• Fast track and patient streaming showed consistent reductions in ED length of stay and left without being seen rates.
• Shifting high-level providers to triage was effective and cost-neutral; other strategies showed less compelling evidence.

Conclusions:

• Fast track implementation and process optimization for key case-mix groups enhance ED throughput.
• Early physician-patient contact at triage is a cost-neutral strategy to improve patient flow.
• Focusing ED staff on operational improvements is key to enhancing performance.