A systematic review of triage-related interventions to improve patient flow in emergency departments
1 Department of Emergency Medicine, Helsingborg Hospital, Helsingborg, Sweden
2 Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden
3 Department of Management and Organisation, Stockholm School of Economics, Stockholm, Sweden
4 Department of Medicine, Uppsala University Hospital, Uppsala, Sweden
5 Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden
6 Department of Medicine, Karolinska Institutet, Solna, Sweden
7 School of Health and Social Studies, Dalarna University, Falun, Sweden
8 Department of Public Health and Clinical Medicine, University Hospital, Umeå, Sweden
9 Department of Clinical Science and Education and Section of Emergency Medicine, Södersjukhuset (Stockholm South General Hospital), Stockholm, Sweden
10 Department of Emergency Medicine, Uppsala University Hospital, Uppsala, Sweden
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011, 19:43 doi:10.1186/1757-7241-19-43Published: 19 July 2011
Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments.
A 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.
The 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.
Introducing 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.