Strategies to measure and improve emergency department performance: a scoping review

Abstract

Background: Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs' capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance. Methods and findings: We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Framework https://osf.io/gkq4t/). 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. Pairs of reviewers independently screened studies' titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. 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). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients' decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains. Conclusions: ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.

Identifying Constraints on Everyday Clinical Practice: Applying Work Domain Analysis to Emergency Department Care

“…These complex socio-technical ecosystems are under continuous pressure to deal efficiently and safely with unpredictable and potentially high-risk patients. Past literature focuses largely on the problems faced by EDs and strategies to improve performance (Austin et al, 2020). While many interventions have improved ED processes, they typically involve incremental adjustments or discrete changes to how EDs operate.…”

The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

“…Patients with shorter EDLOS (<4 h) were found to have significantly higher ISS 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), head AIS 4 (3-5), chest AIS 3 (2-3), abdominal AIS 3 (2-4), pelvis AIS 2 (2-2) and lower mean TRISS (0.89±0.20) and RTS scores (6.67±1.71) than the other groups with longer EDLOS. The frequency of head, chest and abdominal injuries was also significantly higher in patients with shorter EDLOS (<4 h), while spinal (>24 h) and lower extremity injuries (4-12 h) were more common in the long EDLOS group.…”

Tools and Methods Used in Performance Measurement in Healthcare

“…Salvatore ve diğ. [23] Porter'ın modelinin ışığında, sağlık organizasyonlarının değer odaklı bir modele dönüşümüne rehberlik etmeyi hedeflerken, Austin ve diğ., [24] acil servislerin performansını iyileştirmeye odaklanmışlardır. Tüm bu çalışmaların dışında performans değerlendirme konusu ile sağlığa yapılan ödemelerin ilişkisini inceleyen; Gok ve Altındağ [25]; Chen ve Cheng [26]; Cross ve diğ.…”