Use of standardized order sets and associated outcomes in the Emergency Department: A scoping review

Standardized order sets are common in Emergency Departments (EDs), but the extent of use, effectiveness, and associated outcomes remain unclear. The objective of this scoping review was to describe the current evidence regarding standardized order set use in the ED by examining conditions for which order sets are used, implementation and evaluation strategies, and clinical outcomes. We searched MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and the Cochrane Library from inception to April 3, 2025 for studies comparing the use of standardized order sets to usual care for ED patients. Two reviewers independently screened citations and extracted data. We reported study characteristics, order set development and implementation strategies, compliance, and outcomes by target condition. Our search identified 3373 citations and we included 24 studies. There were 19 retrospective, 3 prospective, and 2 before-and-after studies; no randomized trials were identified. Asthma was the most common target condition, followed by sepsis, transient ischemic attack, renal colic, and sickle cell disease. There was significant heterogeneity in the types of outcomes reported as well as the results of the outcomes. Many studies demonstrated improvements in process outcomes such as decreased time to initial therapy and increased adherence to guideline recommended management. Results for patient-oriented outcomes such as hospital admission and ED return visits varied across studies. In the ED setting, order sets may improve process outcomes for many acute conditions; however, the effects on patient-oriented outcomes remain unclear. Order set use in the ED should be accompanied by well-defined development, implementation, and evaluation strategies.