Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review.

Miguel Angel Ortíz-Barrios,Juan-José Alfaro-Saíz

doi:10.3390/ijerph17082664

Abstract

The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

Highlights

Emergency departments (EDs) are perceived as 24/7 portals where a rapid and efficient diagnosis, urgent attention, primary care, and inpatient admission is provided for stabilizing seriously ill and wounded patients, including those with life-threatening conditions ranging from different head injuries to heart failures
Identifying the process-improvement approaches that have been implemented for addressing the top-five leading problems is critical for guiding healthcare managers, decision-makers, researchers, and other stakeholders towards the design of effective interventions improving the emergency care provided to patients while shortening the operational costs
A wide variety of process improvement methodologies have been employed by researchers and practitioners for addressing leading emergency department inefficiencies including Overcrowding, Prolonged waiting time, extended length of stay (LOS), excessive patient flow time, and High number of patients who leave the ED without being seen (LWBS)

Summary

Introduction

Emergency departments (EDs) are perceived as 24/7 portals where a rapid and efficient diagnosis, urgent attention, primary care, and inpatient admission is provided for stabilizing seriously ill and wounded patients, including those with life-threatening conditions ranging from different head injuries to heart failures. EDs play a key social role by offering access to the healthcare system for both insured and uninsured patients. Several serious problems have become glaring in EDs, even in developed countries, and must be thoroughly addressed to ensure low early mortality rates and complications, increased patient satisfaction, timely emergency care, and long-term morbidity. Not surprisingly, these growing deficiencies greatly contribute to the acceleration of healthcare costs which increases the financial pressures on hospitals and shrinks their profits.

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