Authors' objectives:

The main objective of this report was to systematically review the effects of interventions designed to reduce or control overcrowding in the emergency department (ED). Secondary objectives were to provide a descriptive overview of all studies assessing such interventions, and to evaluate their effectiveness and efficiency based on reported outcomes.

Authors' results and conclusions: Of 169 potentially relevant studies, 66 reported interventions to reduce or control ED overcrowding. The number of interventions used per study varied from one to 51. The studies were published between 1990 and 2004, with most being conducted in the US, Canada, and the UK. Interventions that targeted throughput processes were the most commonly studied (51 studies), followed by input (four studies), and output (three studies). The interventions were grouped into fast track (23 studies), multi-faceted interventions (12 studies), staffing changes (eight studies), triage (six studies), diversion strategies (four studies), physician order entry (three studies), and short stay units (two studies). Studies of unique single interventions that could not be placed in any of these categories were considered to be specific processes (eight studies). Most of these have had a positive effect on the overcrowding outcome measured.

Authors' recommendations: Many interventions of varying complexity, intensity, and duration have been applied in an attempt to alleviate or control ED overcrowding. While most seemed to reduce overcrowding, it is difficult to determine the relative value of these interventions, and the lack of comparison studies makes it impossible to say which ones work best. These results suggest that efforts to address overcrowding at an institutional level should be encouraged and monitored, because they have a high chance of success. There is a need for more studies on the specific effects of interventions, and how they might affect the quality of care and patient outcomes. Better reporting is needed on setting characteristics, study design, treatment description, and outcome measures to improve the process of synthesizing evidence on interventions to reduce overcrowding.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.cadth.ca/

Year Published: 2006

URL for published report: https://www.cadth.ca/emergency-department-overcrowding-canada-what-are-issues-and-what-can-be-done

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: <p>Canadian Agency for Drugs and Technologies in Health (CADTH)</p>