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Strategies to measure and improve emergency department performance: a scoping review.
Scand J Trauma Resusc Emerg Med. 2020 Jun 15; 28(1):55.SJ

Abstract

BACKGROUND

Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs' capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance.

METHODS AND FINDINGS

We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Framework https://osf.io/gkq4t/). Eligibility criteria were: (1) review of primary research studies, published in English; (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance; (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies' titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients' decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains.

CONCLUSIONS

ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.

Authors+Show Affiliations

Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. elizabeth.austin@mq.edu.au.Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32539739

Citation

Austin, Elizabeth E., et al. "Strategies to Measure and Improve Emergency Department Performance: a Scoping Review." Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 28, no. 1, 2020, p. 55.
Austin EE, Blakely B, Tufanaru C, et al. Strategies to measure and improve emergency department performance: a scoping review. Scand J Trauma Resusc Emerg Med. 2020;28(1):55.
Austin, E. E., Blakely, B., Tufanaru, C., Selwood, A., Braithwaite, J., & Clay-Williams, R. (2020). Strategies to measure and improve emergency department performance: a scoping review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28(1), 55. https://doi.org/10.1186/s13049-020-00749-2
Austin EE, et al. Strategies to Measure and Improve Emergency Department Performance: a Scoping Review. Scand J Trauma Resusc Emerg Med. 2020 Jun 15;28(1):55. PubMed PMID: 32539739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Strategies to measure and improve emergency department performance: a scoping review. AU - Austin,Elizabeth E, AU - Blakely,Brette, AU - Tufanaru,Catalin, AU - Selwood,Amanda, AU - Braithwaite,Jeffrey, AU - Clay-Williams,Robyn, Y1 - 2020/06/15/ PY - 2020/03/18/received PY - 2020/05/27/accepted PY - 2020/6/17/entrez PY - 2020/6/17/pubmed PY - 2020/6/17/medline KW - Length of stay KW - Observation units KW - Patient satisfaction KW - Point-of-care testing KW - Process re-design KW - Wait-time SP - 55 EP - 55 JF - Scandinavian journal of trauma, resuscitation and emergency medicine JO - Scand J Trauma Resusc Emerg Med VL - 28 IS - 1 N2 - BACKGROUND: Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs' capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance. METHODS AND FINDINGS: We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Framework https://osf.io/gkq4t/). Eligibility criteria were: (1) review of primary research studies, published in English; (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance; (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies' titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients' decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains. CONCLUSIONS: ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines. SN - 1757-7241 UR - https://www.unboundmedicine.com/medline/citation/32539739/Strategies_to_measure_and_improve_emergency_department_performance:_a_scoping_review L2 - https://sjtrem.biomedcentral.com/articles/10.1186/s13049-020-00749-2 DB - PRIME DP - Unbound Medicine ER -
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