Patients’ pathways to the emergency department: a scoping review

Abstract

Background Emergency Department (ED) crowding is a common healthcare issue. The causes are multifactorial, and some causes may be found by analyzing patient trajectories prior to ED visits. The aim of this scoping review is to identify and examine studies that describe patient trajectories prior to ED arrival. Methods The scoping review was performed according to the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A literature search was done to identify studies describing where patients come from and/or their pathway of care before the ED visits. The search was conducted in MEDLINE, Embase, and the Cochrane Library from inception up to March 17th, 2022 and updated on December 5th, 2022. Two reviewers independently screened the records at all stages of the review process. Results Out of 6,465 records screened, 14 papers from Australia, Canada, Haiti, Norway, Sweden, Switzerland, Belgium, Indonesia and the UK met the inclusion criteria. Four studies reported on where patients originated from. Seven studies reported on who referred them. Ten reported how patients were transported and five reported if alternative care or advice was sought prior to visiting an ED. Data were sparse for these categories of information; not all studies reported the full spectrum of patients within each category. Conclusion There are knowledge gaps when it comes to describing patients’ pathways to the emergency department. The data reported provided limited insight, and the lack of uniform data prohibits comparisons across studies. Further studies that comprehensively describe patient trajectories prior to an ED visit are paramount to help understand the reasons for the increased patient influx and ED crowding.