| Summary: | OBJECTIVE: Emergency departments are seeking ways to improve efficiency, but to be useful to decision-makers, studies of such interventions should report information on utilization, cost, and quality of care. Previous systematic reviews have been limited to specific intervention types, and have not assessed implementation costs. We used evidence mapping to assess knowledge gaps and highlight research priorities. METHODS: A systematic literature scan identified studies testing the effect of an improvement intervention on at least one ED utilization measure (eg, length of stay (LOS), waiting-room time (WT), left-without-being-seen (LBWS)). Cost, quality impact, and resource requirement (additional resources needed, existing resources sufficient, unclear) data were abstracted. Studies limited to specific clinical conditions (eg, sepsis, acute myocardial infarction) were excluded. Evidence maps were constructed to illustrate intervention type, resource use, data reporting, and effect size graphically. RESULTS: From 139 titles, N=97 publications were included, describing 17 types of interventions, most commonly physician triage (n=32), nursing scope of practice expansion (n=23), and fast track (n=12). Studies varied in reporting utilization metrics (LOS 69%, WT 38%, LWBS 35%) and implementation costs (20%). Only 3 of 97 studies reported on utilization, resource requirements, costs, and quality measures. Improvements ranged between 5%-20% for LOS, 10%-50% for WT, and -0.5% to 64.7% for LWBS. CONCLUSIONS: Few studies reported the types of data needed to fully assess the effectiveness of efficiency improvement interventions. Future research should emphasize consistent reporting of resource requirements, cost and quality impact data, and how to achieve efficiency improvements without investing new resources. Filling these gaps will make ED efficiency studies more useful to decision-makers
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