Hospital Access Block: A Scoping Review

Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system

“…The number of criteria met varied across the reviews, with the minimum being 5 out of 11 [ 60 ] and the maximum being 11 out of 11 [ 57 , 64 , 66 , 68 ]. Among the assessed reviews, one scoping review was determined to be of low quality [ 60 ], nine were categorised as moderate quality [ 13 , 27 , 34 – 36 , 58 , 73 , 74 , 77 ], and the remaining 27 were deemed high quality [ 7 , 15 , 29 – 33 , 39 , 43 , 55 – 57 , 59 , 61 – 69 , 71 , 72 , 75 , 76 , 78 – 80 ]. Notably, all reviews met criteria 8 and 11, which pertain to the appropriate methods used to combine studies and the recommendations for policy and/or practice supported by the reported data.…”

“…The majority of intervention examples mentioned in the studies were related to the "structural reorganisation/operational changes" subcategory of the "process improvement" category. The most frequent intervention example was "care transitions and discharge management" for timely patient handover and discharge processes, which was extensively discussed in seven studies [ 29 , 30 , 32 , 34 , 67 , 75 , 76 ]. "Fast-track services" for streaming or split-flow processes of nonemergency cases [ 7 , 15 , 34 , 64 , 69 , 73 ] and "team composition interventions" [ 30 , 32 , 60 , 65 , 69 , 74 ] were examined in six studies.…”

“…The most frequent intervention example was "care transitions and discharge management" for timely patient handover and discharge processes, which was extensively discussed in seven studies [ 29 , 30 , 32 , 34 , 67 , 75 , 76 ]. "Fast-track services" for streaming or split-flow processes of nonemergency cases [ 7 , 15 , 34 , 64 , 69 , 73 ] and "team composition interventions" [ 30 , 32 , 60 , 65 , 69 , 74 ] were examined in six studies. It was observed that most interventions focused on the "within-ED" phase and the "ward departure" phase of the "posted" phase, involving actions taken while patients were in the ED or ward.…”

“…Overall, most interventions within this category had mixed or nonsignificant outcomes. Some interventions related to residential care facilities and home departure, including "on-site primary and acute treatment for specific conditions in long-term care facilities" [ 65 , 71 ], "Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) of long-term care patients" [ 71 ], "implementation of extended care paramedics in long-term care centres" [ 71 ], "providing long-term care facilities" [ 34 ], and "home-based healthcare optimisation" [ 34 , 74 ], had positive outcomes.…”

“…The most frequently mentioned interventions within the infrastructure category included the “implementation of simulation and predictive models or the utilisation of predictive tools” [ 29 , 30 , 35 , 72 , 73 , 75 ], as well as “electronic board tracking or electronic patient tracking systems” [ 7 , 15 , 34 , 35 , 64 , 75 ] (Table 7 ). These interventions received more attention in six studies, primarily addressing the "within-ED" phases, as well as the "ward departure" phase during “post-ED” processes.…”