BackgroundOvercrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments.MethodsA systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group.ResultsThe interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient.ConclusionsIntroducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.
Theories on R&D organisation draw on globalisation literature as well as on communication theories. This mixed discourse is a problem, since mixing levels of logic sometimes cause faulty conclusions. How is this double logic handled in organisations, and what is the effect on R&D organisation? This study investigates R&D activities in multinational companies with several production sites and markets, focusing what reasons and forces are mentioned in relation to the geographical structure of the R&D activities. We assume that there are opposing forces, both dispersing and contracting the R&D activities geographically. The purpose of the paper is to investigate perceived geographically dispersing and contracting forces on R&D activities, and how a possible conflict between these is handled. This is done by studying how the level of dispersion has come to be, what events or decision has caused the dispersion of R&D. We show that trends in R&D dispersion are active in two directions, one dispersing and one contracting, and that these are partly working at separate organisational levels. The dispersing forces are more prevalent at strategic levels, while the contracting forces are more pronounced at the operational level.
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