Interventions to reduce overcrowding in emergency departments: An umbrella review
Abstract
Objective: To identify and evaluate the effectiveness of interventions and/or strategies to reduce overcrowding in Emergency Departments (EDs).
Method: An umbrella review was performed using the JBI method. Eight search resources were considered. Two independent reviewers carried out the selection of studies, quality assessment, data extraction, and synthesis.
Results: Twenty systematic reviews were included, which identified several interventions to reduce overcrowding in EDs, such as: joint triage (physicians and nurses); creation of fast tracks; introduction of Rapid Assessment Units; request for auxiliary diagnostic tests by nurses; streaming; collaboration with Primary Health Care (PHC) for referral of non-urgent cases; allocation of PHC units within or adjacent to EDs; triage by PHC professionals; extension of PHC hours; increase in hospital capacity; creation of full capacity protocols; hiring of specialist professionals; lean thinking; reverse triage. The most effective interventions and/or strategies were: joint triage; creation of fast-track routes; introduction of rapid assessment units; request for auxiliary diagnostic tests by nurses; streaming; and collaboration with PHC for referral of non-urgent cases.
Conclusion: The combination of effective triage, appropriate flow management, and proactive action by the team appears to be key to mitigating overcrowding in the EDs. Joint triage and fast-track routes are the most effective measures. The expanded role of…
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