PLoS ONE· 2018Q1· Review
Emergency department crowding: A systematic review of causes, consequences and solutions
- 1,338citations
- Q1SCImago
- 2018year
Short summary
This systematic review found a significant mismatch between the identified causes of emergency department (ED) crowding and the solutions implemented, with most solutions focusing internally on patient flow rather than addressing external drivers like primary care access and timely hospital discharge.
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Key points
- 102 studies were included in the review, with 51% trialling or modeling solutions.
- Negative consequences of ED crowding include poorer patient outcomes and staff inability to follow guidelines.
- Key causes identified are patient attendance (number/type) and discharge delays.
- Most solutions focus on internal ED patient flow, not external drivers.
- System-wide initiatives and extended primary care hours showed promising results.
AI-generated from the title and abstract; the full text is not read.
Abstract
BACKGROUND: Emergency department crowding is a major global healthcare issue. There is much debate as to the causes of the phenomenon, leading to difficulties in developing successful, targeted solutions. AIM: The aim of this systematic review was to critically analyse and summarise the findings of peer-reviewed research studies investigating the causes and consequences of, and solutions to, emergency department crowding. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A structured search of four databases (Medline, CINAHL, EMBASE and Web of Science) was undertaken to identify peer-reviewed research publications aimed at investigating the causes or consequences of, or solutions to, emergency department crowding, published between January 2000 and June 2018. Two reviewers used validated critical appraisal tools to independently assess the quality of the studies. The study protocol was registered with the International prospective register of systematic reviews (PROSPERO 2017: CRD42017073439). RESULTS: From 4,131 identified studies and 162 full text reviews, 102 studies met the inclusion criteria. The majority were retrospective cohort studies, with the greatest proportion (51%) trialling or modelling potential solutions to emergency department crowding. Fourteen studies examined causes and 40 investigated consequences. Two studies looked at both causes and consequences, and two investigated causes and solutions. CONCLUSIONS: The negative consequences of ED crowding are well established, including poorer patient outcomes and the inability of staff to adhere to guideline-recommended treatment. This review identified a mismatch between causes and solutions. The majority of identified causes related to the number and type of people attending ED and timely discharge from ED, while reported solutions focused on efficient patient flow within the ED. Solutions aimed at the introduction of whole-of-system initiatives to meet timed patient disposition targets, as well as extended hours of primary care, demonstrated promising outcomes. While the review identified increased presentations by the elderly with complex and chronic conditions as an emerging and widespread driver of crowding, more research is required to isolate the precise local factors leading to ED crowding, with system-wide solutions tailored to address identified causes.
The authors' abstract, as published at the source. PLoS ONE, 2018 · DOI ↗
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Field: Emergency Medicine
Emergency MedicineMedicine