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Interventions to reduce emergency department consultation time: A systematic review of the literature

  • Weiwei Beckerleg (a1) (a2) (a3), Krista Wooller (a1) (a2) (a3) (a4) and Delvina Hasimjia (a1) (a2) (a3)

Abstract

Objectives

Overcrowding in the emergency department (ED) is associated with increased morbidity and mortality. Studies have shown that consultation to decision time, defined as the time when a consultation has been accepted by a specialty service to the time when disposition decision is made, is one important contributor to the overall length of stay in the ED.

The primary objective of this review is to evaluate the impact of workflow interventions on consultation to decision time and ED length of stay in patients referred to consultant services in teaching centres, and to identify barriers to reducing consultation to decision time.

Methods

This systematic review was performed in accordance with the PRISMA guidelines. An electronic search was conducted to identify relevant studies from MEDLINE, EMBASE, Cochrane Central, and CINAHL databases. Study screening, data extraction, and quality assessment were carried out by two independent reviewers.

Results

A total of nine full text articles were included in the review. All studies reported a decrease in consultation to decision time post intervention, and two studies reported cost savings. Interventions studied included short messaging service (SMS) messaging, education with audit and feedback, standardization of the admission process, implementation of institutional guideline, modification of the consultation process, and staffing schedules. Overall study quality was fair to poor.

Conclusions

The limited evidence suggests that audit and feedback in the form of SMS messaging, direct consultation to senior physicians, and standardization of the admission process may be the most effective and feasible interventions. Additional high-quality studies are required to explore sustainable interventions aimed at reducing consultation to decision time.

RésuméContexte

L'encombrement des services des urgences (SU) est associé à une augmentation de la morbidité et de la mortalité. Des études ont démontré que le temps écoulé entre les demandes de consultation et les prises de décision, défini comme le temps passé entre le moment où une demande de consultation en spécialité est acceptée et la prise de décision quant aux suites à donner, joue un rôle important dans le prolongement de la durée totale de séjour au SU.

Objectifs

L’étude avait pour objectifs principaux d’évaluer l'incidence des interventions de rationalisation du travail sur le temps écoulé entre les demandes de consultation et les prises de décision et sur la durée de séjour au SU chez les patients dirigés vers des services de consultation dans des centres hospitaliers d'enseignement, et de cerner les obstacles à la réduction de ce temps d'attente.

Méthode

Il s'agit d'une revue systématique réalisée conformément aux lignes directrices PRISMA. Une recherche électronique a été menée dans les bases de données MEDLINE, EMBASE, Cochrane Central et CINAHL afin de relever les études pertinentes. Deux examinateurs ont procédé, chacun de leur côté, à la sélection des études, à l'extraction des données et à l’évaluation de la qualité des études retenues.

Résultats

Ont été sélectionnés, au total, 9 articles en version intégrale. Dans toutes les études, on faisait état, après les interventions, d'une diminution du temps écoulé entre les demandes de consultation et les prises de décision et, dans deux études, d'une économie de coûts. Parmi les interventions examinées, il y avait les services de messages courts (SMS), la formation du personnel suivie de contrôles et de commentaires, l'uniformisation du processus d'admission, la mise en œuvre de lignes directrices dans les établissements, la modification du processus de consultation et les horaires de travail du personnel. Dans l'ensemble, la qualité des études variait de passable à piètre.

Conclusions

Malgré le petit nombre de données probantes, il semblerait que les contrôles et les commentaires sous forme de SMS, les demandes de consultation envoyées directement aux médecins principaux et l'uniformisation du processus d'admission soient les interventions les plus efficaces et les plus faciles à mettre en œuvre. Il faudrait aussi réaliser des études de qualité sur des interventions durables visant à réduire le temps écoulé entre les demandes de consultation et les prises de décision.

Copyright

Corresponding author

Correspondence to: Dr. Krista R. Wooller, Division of General Internal Medicine, D107c Civic Campus Box 209, 1053 Carling Avenue, Ottawa, ONK1Y 4E9; Email: krwooller@toh.ca

References

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Interventions to reduce emergency department consultation time: A systematic review of the literature

  • Weiwei Beckerleg (a1) (a2) (a3), Krista Wooller (a1) (a2) (a3) (a4) and Delvina Hasimjia (a1) (a2) (a3)

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