Analysis of the Literature on Emergency Department Throughput

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.