Analysis of the Literature on Emergency Department Throughput

Rosalind Franklin University of Medicine and Science/Chicago Medical School, Department of Emergency Medicine.
The western journal of emergency medicine 06/2009; 10(2):104-9.
Source: PubMed


The purpose of this paper was to review and analyze all the literature concerning ED patient throughput. The secondary goal was to determine if certain factors would significantly alter patients' ED throughput.
A MEDLINE search was performed from 1966 to 2007 using the terms "turnaround," "emergency departments," "emergency medicine," "efficiency," "throughput," "overcrowding" and "crowding." Studies were graded using a scale of one to four based on the ACEP paper quality criteria. Inclusion criteria were English language and at least a level four or better on the quality scale. An analysis of successful procedures and techniques was performed.
Literature search using the key terms found 29 articles on turnaround times, 129 on ED efficiency, 3 on throughput, 64 on overcrowding and 52 on crowding. Twenty-six articles were found to meet the inclusion criteria. There were three level I studies, thirteen level II studies, five level III studies and five level IV studies. The studies were categorized into five areas: determinants (7), laboratories processes (4), triage process (3), academic responsibilities (2), and techniques (10). Few papers used the same techniques or process to examine or reduce patient throughput precluding a meta-analysis.
An analysis of the literature was difficult because of varying study methodologies and less than ideal quality. EDs with combinations of low inpatient census, in-room registration, point of care testing and an urgent care area demonstrated increased patient throughput.

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    • "Some factors are intrinsic to the nature of the hospital and catchment community, such as annual hospital volume, patient acuity, and patient socioeconomic status. Other factors relate to hospital management and administrative decisions such as physician and employee staffing, input and throughput processes, and hospital patient flow [3]. ED crowding is an increasing national problem that adversely impacts patient care and negatively affects ED operations [4]. "
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    • "e l s e v i e r . c o m / l o c a t e / a j e m economics of the hospital [29], SBIRT program administrators must structure programs to avoid slowing down ED throughput while maximizing program service delivery. Despite the challenges, near universal screening (97%) for harmful alcohol and drug use can be achieved by embedding a short screening tool into an ED's electronic triage system [30]. "
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    American Journal of Emergency Medicine 10/2014; 33(1). DOI:10.1016/j.ajem.2014.10.021 · 1.27 Impact Factor
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