Interventions to reduce emergency department consultation time: A systematic review of the literature

Beckerleg, Weiwei; Wooller, Krista; Hasimjia, Delvina

doi:10.1017/cem.2019.435

Cited by 10 publications

(20 citation statements)

References 28 publications

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“…Secondly, we should increase the number of doctors and give each patient enough time to visit. Until the outbreak of the epidemic, doctors in the capital cities of provinces were only able to see patients for 3–5 min, and the amount of time individuals were allowed to see a patient was diminished considerably ( 38 ). After the outbreak of COVID-19, doctors have become more difficult to interview.…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on the doctor-patient relationship in China

2022

Front. Public Health

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A strong doctor-patient relationship (DPR) is crucial to the effectiveness of treatment. It is imperative to maintain a good DPR during treatment. During 2019, Coronavirus Disease 2019 (COVID-19) brought new challenges to already difficult doctor-patient relationships. This paper summarized the current state of the DPR, compared the changes between China and other countries after the outbreak of COVID-19, and listed the solutions proposed by various countries. Finally, the author suggested some solutions in order to improve the DPR according to China's own circumstances.

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Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on the doctor-patient relationship in China

2022

Front. Public Health

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“… 5 Others have shown improvements in consult response time and LOS by implementing structures around communication. 6 , 7 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Improvements to emergency department length of stay and user satisfaction after implementation of an integrated consult order

et al. 2023

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Objective Subspecialty consultation in the emergency department (ED) is a vital, albeit time consuming, part of modern medicine. Traditional consultation requires manual paging to initiate communication. Although consult orders through the electronic health record (EHR) may help, they do not facilitate 2‐way communication. However, the impact of combining these systems within the EHR is unknown. We estimated the effect of implementing an integrated paging system on ED workflow efficiency and user attitudes. Methods We integrated a messaging system into order entry at our tertiary care academic ED, such that placing a consult order simultaneously paged the consultant. We measured ED workflow efficiency metrics (length of stay [LOS], consult initiation time) and MD/nurse practitioner (NP)/physician assistant (PA) attitudes (perceived mis‐pages, efficiency, and workflow preference) 3 months before and 6 months after the implementation. Results Six months after implementation, there was 25% use of the new workflow. During the pre‐implementation phase, the median time to consult initiation and ED LOS were 150 and 621 minutes, respectively. Implementation of the order was associated with a 15‐minute reduction in median time to consult initiation ( P < 0.001), and a 52‐minute reduction in median ED LOS ( P < 0.001). ED MDs/NPs/PAs perceived a reduction in the rate of mis‐pages, improved efficiency, and overall preferred the new workflow. Conclusions We consolidated steps in the ED consult workflow using an integrated consult order, which improved user satisfaction, and reduced consult initiation time and ED LOS for patients requiring a consult at an urban tertiary care ED.

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“…Systematic reviews assessing interventions to improve ED throughput have generally not focused on the impact of interventions targeting the ED consultation process 8,9 . One previous systematic review reported that interventions aiming to reduce consultation to decision time were generally effective; however, the methodological quality of the available studies was poor, the review is dated, and new evidence could clarify their impact on practical measures of ED throughput 5 . The objective of this systematic review was to describe and evaluate the effectiveness of interventions aiming to improve the ED consultation process.…”

Section: Introductionmentioning

confidence: 99%

“…1 Research shows that increased ED LOS results in decreased patient satisfaction, increased hospital admissions, and increased mortality. 3,4 Various types of interventions impacting the specialist consultation process, including reducing wait times for responding and completing consultations, 5 early identification of patients most likely requiring consultation, 6 and limiting unnecessary consultations, have been thought to improve ED throughput and reduce overcrowding. 7 The overall effectiveness of ED-based interventions that specifically influence the consultation process, however, is not well understood.…”

Section: Introductionmentioning

confidence: 99%

Interventions to improve consultations in the emergency department: A systematic review

Voaklander

Gaudet

Kirkland

et al. 2022

Academic Emergency Medicine

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Objectives Emergency department (ED) consultations with specialists are necessary for safe and effective patient care. Delays in the ED consultation process, however, have been shown to increase ED length of stay (LOS) and contribute to ED crowding. This review aims to describe and evaluate the effectiveness of interventions to improve the ED consultation process. Methods Eight primary literature databases and the gray literature were searched to identify comparative studies assessing ED‐based interventions to improve the specialist consultation process. Two independent reviewers identified eligible studies, assessed study quality, and extracted data. Individual or pooled meta‐analysis for continuous outcomes were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random‐effects model was conducted. Results Thirty‐five unique comparative intervention studies were included. While the interventions varied, four common components/themes were identified including interventions to improve consultant responsiveness (n = 11), improve access to consultants in the ED (n = 9), expedite ED consultations (n = 8), and bypass ED consultations (n = 7). Studies on interventions to improve consult responsiveness consistently reported a decrease in consult response times in the intervention group with percent changes between 10% and 71%. Studies implementing interventions to improve consult responsiveness (MD −2.55, 95% CI −4.88 to –0.22) and interventions to bypass ED consultations (MD −0.99, 95% CI −1.43 to –0.56) consistently reported a decrease in ED LOS; however, heterogeneity was high (I2 = 99%). Evidence on whether any of the interventions were effective at reducing the proportion of patients consulted or subsequently admitted varied. Conclusions The various interventions impacting the consultation process were predominately successful in reducing ED LOS, with evidence suggesting that interventions improving consult responsiveness and improving access to consultants in the ED also improve consult response times. Health care providers looking to implement interventions to improve the ED consultation process should identify key areas in their setting that could be targeted.

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Interventions to reduce emergency department consultation time: A systematic review of the literature

Cited by 10 publications

References 28 publications

The impact of COVID-19 on the doctor-patient relationship in China

The impact of COVID-19 on the doctor-patient relationship in China

Improvements to emergency department length of stay and user satisfaction after implementation of an integrated consult order

Interventions to improve consultations in the emergency department: A systematic review

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