Abstract
BackgroundThe growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions.MethodsSix major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects.ResultsOf the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician.ConclusionInter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention’s effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures.Trial registrationThe protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).
Highlights
The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time
We found only one controlled before-after (CBA) study that explicitly addressed the problem of crowding as the leading motive for intervention development and testing [37]
Given the global aging population and its impact on the growing problem of ED crowding, there is an urgent need to focus future research on intervention studies aimed at improving the organization and efficiency of care for older adults in the ED
Summary
The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. ED crowding can be defined as a situation in which the demand for emergency services exceeds the ability of physicians and nurses to provide quality care within a reasonable time [3, 4]. This phenomenon often occurs when EDs need to care for a greater number of patients than they are ideally designed for [3]. ED crowding is associated with increased adverse clinical outcomes [5,6,7,8,9,10], care delays [6, 11,12,13], patient dissatisfaction
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