A systematic review of triage-related interventions to improve patient flow in emergency departments

Abstract

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.

A model of complaint based for overcrowding emergency eepartment: Five-Level Hacettepe Emergency Triage System

“…[1][2][3][4][5][6][7][8][9][10][11][12] Five-level triage systems have been commonly used in emergency departments of countries where emergency medical services have been developed. [23][24][25][26][27][28] In the United States, ESI has emerged as a new triage system in which education and experience are needed; it is the most widely used and is the most valuable of emergency triage systems.…”

“…[1][2][3][4][5][6][7][8][9] Inappropriate care areas and long durations for care in overcrowded emergency departments cause problems between patients and health care providers. [10][11][12][13][14] Different triage systems (2-Level, 3-Level, 4-Level and 5-Level) have been applied to determine the priority and management of health care for emergent patients in emergency departments.…”

Tools for Process Optimizing in Emergency Departments

“…Introducing symptoms along with prehospital triage makes sense to the general practitioner and also to the paramedics. In other words, the communication to the hospital can be standardized from the main symptom along with a triage colour/digit [5].…”

Short tracks are sometimes the best

“…Il s'agit de la première étude française publiée sur le sujet. Elle confirme un certain nombre de résultats déjà notés dans d'autres études, notamment une méta-analyse qui montrait une réduction significative du temps de passage pour les malades de niveaux 4 et 5 dans l'échelle de triage australienne [2]. Dans l'article de Saidi et al…”