Understanding how ED performance has been measured in the past will support the selection of measures and inform the development of new measures to address gaps in performance knowledge. It is unsurprising then that input, throughput and output measures such as wait-time, length of stay and patient satisfaction have been used to report on EDs’ performance. Ideally, the design and selection of performance measures should align with the system’s purpose and improvement strategy in order to identify the extent to which the system is working effectively. Understanding the characteristics of those interventions and their limitations can inform the development of new strategies to address common patient flow problems. Identifying effective interventions known to have improved care can support the uptake of those interventions in different contexts. Interventions (e.g., decision-making structure, resource allocation, procedures) to address these factors have been widely implemented, with mixed results. Ĭrowding in EDs is the product of input, throughput and output factors such as the volume of patients arriving to be seen, the time taken to assess and treat patients, and the availability of beds in hospital wards. It extends the time patients spend in ED, and threatens patient outcomes. However, crowding impedes ED staffs’ capacity to provide timely, safe and quality care. EDs must continue to provide care during periods of crowding, and respond to expected changes (e.g., seasonal increase in demand) and unexpected changes (e.g., unanticipated events and varying demand). Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Interventions to improve ED performance address a broad range of ED processes and disciplines. ConclusionsĮD performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Few interventions reported outcomes across all five outcome domains. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients’ decisions and providing education. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Three reviews identified 202 individual indicators of ED performance. Narrative synthesis was performed on the 77 included reviews. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Independent reviewers extracted data using a tool specifically designed for the review. Discrepancies were resolved via discussion. Pairs of reviewers independently screened studies’ titles, abstracts, and full-texts for inclusion according to pre-established criteria. Eligibility criteria were: (1) review of primary research studies, published in English (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance (3) focuses on a hospital ED context in any country or healthcare system. We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to Jprospectively registered in Open Science Framework ). This review aims to map the research evidence provided by reviews to improve ED performance. Crowding is a complex and challenging issue that affects EDs’ capacity to provide safe, timely and quality care.
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