Table 2 Summary characteristics of included reviews

AM,

2022 Australia [13]

Solutions to access block; present recommendations for evidence-based access block solutions for piloting and/or implementation in Australia and Aotearoa New Zealand

ScR

Not reported—however patients in ED

Retrieved: 199 Included: not clear (2000–2022)

Qualitative Quantitative studiSes

Australia,

Europe,

North America,

Japan,

Taiwan,

Hong Kong,

Singapore,

South Korea,

South America

CINAHL,

Medline,

Embase,

WOS

Not appraised

Not stated- however narrative synthesis

Austin,

2020 Australia [30]

To map the research evidence provided by reviews on strategies to measure and improve ED performance

ScR

Clinicians, patients, and/or administrators in the ED

77

(2000–2019)

SR

PR

UR

IR

CR

Subs R

RR

SCR

EBR,

NR,

Mas

Denmark, Canada,

USA,

England, Australia,

Hong Kong, Sweden,

Italy,

Iran,

New Zealand, Brazil,

South Korea, Switzerland

Cochrane,

Scopus,

Embase

CINAHL,

PubMed

-ROBIS tool

1 low bias,

31 high bias,

15 unclear bias

Narrative synthesis

Beckerleg, 2020

Canada

[31]

To identify what interventions have been tried to reduce consultation to decision time and, in turn, ED length of stay

SR

Adult patients (> / = 18 years of age)

9

(2011–2018)

RCR

RBAs

PBAs

South Korea, Canada,

USA

MEDLINE, EMBASE, Cochrane,

CINAHL

SQUIRE 2.0 checklist

3 poor,

5 fair,

1 good

Descriptive qualitative analysis

Benabbas, 2020

USA [55]

To ascertain the role of triage liaison providers in improving throughput metrics to minimise patient risk and improve safety and quality metrics set forth by CMS

SR & Mas

Patients in the ED

(329,340)

12

(2001–2019)

RBAs

PBAs

CBAs

USA

PubMed,

EMBASE,

WOS,

www.ntis.gov,

clinicaltrials.gov,

SAEM,

ACEP,

AAEM,

Opengrey,

Google scholar

EPHPP

66.7% moderate,

33.3% weak

Meta-analysis

Berning, 2020

USA [32]

To summarise interventions that impact the experience of older adults in the ED as measured by patient experience instruments

SR

Older adults

(3163)

21

(1996–2018)

RCT

QE

Obs

B & A

USA

UK

Australia

Sweden, Canada Korea

Scotland

Ovid Central,

Ovid EMBASE,

Ovid, MEDLINE PsycINFO,

Clinicaltrials

GRADE

Newcastle‒Ottawa Scale

Modified tool

GRADE:

ROBIS tool: 13 high,

4 moderate,

4 low

Qualitative analysis

Bittencourt, 2020

Brasil [27]

To present an overview of systematic reviews on throughput interventions to solve the overcrowding of emergency departments

UR

N/A

15

(2007–1016)

SR

Australia, Netherlands, USA,

Italy

PubMed,

Cochrane, EMBASE,

Health Systems Evidence,

CINAHL,

SciELO,

LILACS,

CAPES portal,

Google scholar

AMSTAR 2

3 critically low,

4 low,

6 moderate,

2 high

Narrative synthesis

Blodgett 2021

UK [56]

To identify all studies that examined alternate routes of care for the nonurgent "intermediate" patient instead of ED conveyance

ScR

N/A

41

(2000–2020)

Qualitative

Quantitative

Consensus-base (Commentaries

Protocols

Policy)

UK, Sweden, Netherlands, USA, Australia, Canada, Ireland

PubMed, CINAHL,

WOS

ProQuest

NHS Evidence, CORE,

BL.UK,

Open-Grey, HMIC

Modified 7-level rating system for the hierarchy of evidence

2 Level 2,

4 Level 3,

11 Level 4,

13 Level 6,

11 level 7

Narrative synthesis

Boylen

2020

Australia [57]

To identify, critically appraise and synthesise evidence on the impact of professional interpreters on outcomes for hospitalised children from migrant and refugee families with limited English proficiency

SR

Limited-English-proficient migrant, refugee or asylum-seeker families with a hospitalised child used a professional interpreter

(1813 families)

6

(2004–2018)

Quantitative

RCTs

QE

and descriptive

USA

CINAHL Plus, Ovid,PubMed, ProQuest, Scopus,

WOS, Embase, PsycINFO,

Science Direct, APAIS Health, AIHW, AustHealth, Factiva,

TROVE & OIASTER, Google Scholar

JBI checklists,

JBI SUMARI,

GRADE

4 Moderate,

2 high

Narrative synthesis

Brambilla

2022

Italy [58]

To shed light on the Free Standing Emergency Department (FSED) model and compare it with the traditional Hospital Based Emergency Department (HBED) in international contexts

SR

N/A

23

(2010–2021)

LR,

CS,

Theoretical studies, Applied studies

USA, France, Spain, Sweden, Italy

CINAHL,

Scopus,

PubMed,

WOS

Not appraised

Narrative synthesis

Burgess

2021

Australia [33]

What is the effectiveness of nurse-initiated interventions on patient outcomes in the emergency department?

SR

All patients accessing treatment in an ED setting;

(12 studies paediatric patients only, 14 studies adult patients only)

(9144)

26

(2000–2019)

RCT,

QE

Australia, USA, Netherlands, Hong Kong, Sweden, Canada,

Iran,

Saudi Arabia

PubMed,

CINAHL,

Embase,

PsycINFO,

WOS,

Cochrane Central,

Register of Controlled Trials,

ProQuest

Mednar

JBI checklists for experimental and quasiexperimental studies

4 < 50%,

1 50—69%,

17 > 69%

Quantitative

Analysis

(Meta-analysis) &

Qualitative analysis

Cassarino 2019

Ireland [59]

To synthesise the totality of evidence relating to the impact of early assessment and intervention by Health and Social Care Professional teams on quality, safety, and effectiveness of care in the ED

SR

adults > / = 65 years old who present to the ED

(273,886)

6 (2002–2013)

nRCTs CBAs

ITS

RMS

Australia

CINAHL,

Embase,

Cochrane Library, MEDLINE

Cochrane EPOC

6 high risk of selection bias and

6 unclear/high risk of performance bias

Narrative/

qualitative synthesis

Clark

2022

Australia [34]

To lead one through the patient journey and explore scholarly solutions from a diverse body of literature and methodologies to address bottlenecks in access and care delivery

ScR

N/A

43

(215–2021)

Quantitative,

Qualitative

mixed-methods,

NR,

ScR, Discussion papers

Trinidad, Kuwait,

Iran,

Canada,

USA, Australia,

New Zealand, Europe, France,

China, Sweden,

UK

CINAHL, Embase,

ProQuest,

PubMed,

Cochrane Library

Not appraised

Narrative synthesis

DeFreitas 2018

UK [7]

To provide a comprehensive analysis of the evidence from existing systematic reviews on the interventions that improve ED patient flow

UR

N/A

13

(2006–2016)

SR

USA, Sweden, Australia, Canada, Korea, France, Germany,

New Zealand, Saudi Arabia, Singapore, Switzerland, Turkey, Jamaica

Ovid,

EMBASE CINAHL, Cochrane library, JBI,

ProQuest,

Open Grey,

Google Scholar

AMSTAR 2

5 high,

3 Moderate,

3 Low,

2 Critically, low

Narrative synthesis

DiLaura 2021

Italy [35]

To review the literature on the issues encountered in the efficiency of EDs worldwide

SR

N/A

28

(2010–2019)

Obs, Modelling studies, QE,

CRT

USA, Australia, Canada, China, France, Italy, Portugal, Sweden, Netherlands, Germany, UK

PubMed,

Scopus,

Cochrane library

Not appraised

Descriptive analysis

Franklin

2022

USA [60]

To characterise the evidence related to hospital capacity command centers and synthesises current data regarding their implementation

ScR

N/A

8

(2015–2019)

nCBAs

USA

PubMed,

ABI ProQuest, Grey literature sources

Not appraised

Descriptive synthesis

Gonçalves-Bradley

2018

UK [61]

The aim of this Cochrane Review was to determine whether placing primary care professionals, such as general practitioners, in the hospital ED to provide care for patients with nonurgent health problems can decrease resource use and costs

SR

11,463 patients,

16 GPs,

9 eNPs,

69 emergency physicians

4

(1995–2015)

RCT

nRCT

B & A

TS

Australia, Ireland,

UK

Cochrane library, MEDLINE, Embase, CINAHL, PsycINFO,

Grey literature,

WHO ICTRP,

Clinicaltrials.gov

GRADE

EPOC

4 very low EPOC: high risk of bias

Quantitative

Analysis (Forest

plots without summary estimates)

Gottlieb 2021

USA [62]

To review the medical literature to determine the utility of triage-ordered testing and to offer evidence-based recommendations to emergency physicians

SR

Triage nurse,

ED patients

(Not reported)

13

(1990–2018)

RCTs,

SR,

Obs

USA

UK

Australia

Sweden, Canada, China,

HongKong

PubMed

A grade of evidence

1 outstanding, 4 good,

5 adequate,

3 poor

Narrative synthesis

Gottlieb 2021

USA [63]

Effect of Medical Scribes on Throughput, Revenue, and Patient and Provider Satisfaction: A Systematic Review and Meta-analysis

SR & MA

Medical scribes,

ED patients

562,682 patient encounters

39

(2010–2020)

RCT,

nRCT,

RBAs, PBAs

USA,

Canada, Australia

PubMed, Scopus, the Cumulative Index of Nursing and Allied Health Literature,

Latin American and Caribbean Health Sciences Literature database, Google Scholar, Cochrane library,

ACEP,

SAEM

CAEP

Newcastle‒Ottawa scale, Cochrane ROBIS Tool,

GRADE criteria

Studies were deemed to be good quality overall

Meta-analysis

Grant

2020

Canada [64]

To evaluate and summarise the results of studies describing ED throughput interventions

SR

N/A

101

(1996–2020)

RCT,

B & A Cohort,

CS,

Obs,

RCR

USA, Canada, Sweden, Australia, Netherlands, Spain,

UK,

Turkey, Pakistan, Finland, Korea, Jamaica, Taiwan

Medline, Embase, CINAHL, Cochrane Central

Cochrane ROBIS tool,

NHLBI

19 good,

67 fair,

5 poor (NHLBI)

3 low,

5 some concerns (Cochrane)

Narrative synthesis

Meta-analysis

Grant

2020

Canada [65]

To review, categorise and evaluate interventions to reduce preventable long-term care facility transfers to ED

ScR

Residents in long term care facilities

(80,791

sample size)

26

(1988–2018)

RCT, Obs,

Cohort, QE, B&A, RCT, cross-ectional,

TS study,

nRCT

Not reported

Medline, EMBASE, CINAHL

NHLBI

11 good,

14 fair,

1 poor

Narrative synthesis

Hesselink 2019

Netherlands [66]

Effectiveness of interventions to alleviate ED crowding by older adults: a systematic review

SR

Older adults (≥ 60 years of age)

(Not reported)

16

(1996–2006)

RCT,

nRCT,

CBAs

US,

Canada,

UK, Australia, Singapore

CINAHL, Cochrane Library, EMBASE, PsychInfo,

Grey literature,

Cochrane EPOC

12 high risk,

2 low risk,

2 moderate risk of bias

Quantitative

Analysis

Hong

2020

Canada [36]

To understand the association between improved access to after-hours primary care and both ED and primary care utilisation

SR

N/A

20

(2000–2020)

cross-sectional, B&A

US, Australia, Belgium, England, Ireland, the Netherlands, Canada, Italy, Scotland

CINAHL, EMBASE, MEDLINE,

Scopus,

Google Scholar

Not appraised

Descriptive Synthesis

Hughes

2019

USA [67]

To evaluate the effect of ED interventions on clinical, utilisation, and care experience outcomes for older adults

SR

Older adults > / = 65

Not reported

17 references

(15 unique studies)

(1996–2017)

RCT,

nRCT,

CBAs

OECD countries: Australia, Canada, Europe, USA

PubMed,

Embase,

CINAHL, PsycINFO, ClinicalTrials.gov, Scopus

Cochrane EPOC,RADE

For Objective outcomes:

7 high risk,

3 unclear,

4 low risk,

1 NA

Quantitative synthesis when was possible,

Jeyaraman

2022

Canada [68]

Impact of employing primary healthcare professionals (PHCPs) in ED triage on patient flow outcomes: a systematic review and meta-analysis

SR & MA

PHCPs,

ED patients

40

(1993–2020)

B&A,

RCT,

Cohort studies,

CBAs,

QE,

Cross-sectional,

Obs

Saudi Arabia, Oman,

UK,

USA, Canada, Australia, France, China, Netherlands

Ovid,

Cochrane Library,

CINAHL

NICE quality appraisal tool

33 low quality,

7 moderate quality

Meta-analysis

Jeyaraman 2021

Canada [69]

To conduct a scoping review to identify and summarise the literature on interventions involving primary healthcare professionals to manage ED overcrowding

ScR

N/A

268 studies (274 reports)

(1981–2020)

RCTs,

nRCT,

Cohort studies,

CS,

Cross-sectional,

B&A,

TS,

Mixed-methods

USA,

UK,

Canada, Australia, Netherlands, Switzerland, Sweden, France,

Italy,

South Korea, China, New Zealand, Saudi Arabia, Taiwan, Belgium, Brazil, Finland, Oman, Portugal, Spain, Singapore

Ovid,

Cochrane Library,

CINAHL,

CFHI,

IHI website,

AHRQ website,

NHS Improvement,

ISQUA,

Quality Ontario,

Saskatchewan Health Quality,

HQCA,

BCPCQC,

Australian Commission on Safety and Quality in Health Care,

HQSC New Zealand

Not appraised

Descriptive statistical analyses

Kirkland

Canada

2019 [70]

To examine the effectiveness and safety of prehospital and ED-based diversion strategies on ED utilisation, non-ED healthcare utilisation and patient outcomes compared with standard emergency care responses

SR

Low-acuity ED patients

Not reported

15

(2002–2017)

RCT,

Cohort studies

England, USA, Scotland, Wales, Sweden

Medline,

Embase,

Cochrane Library,

PsycINFO, CINAHL,

Social Services Abstracts, ProQuest,

Google Scholar,

ClinicalTrials.gov,

SAEM,

CAEP

Newcastle‒Ottawa Scale, Cochrane ROBIS tool

10 high or unclear,

5 moderate

Meta-analyses

Leduc

2021

Canada [71]

To identify existing programs where allied healthcare personnel are the primary providers of the intervention and to evaluate their effectiveness and safety

SR

Adult patients living in long term care centres

Not reported

22

(2013–2018)

RCTs,

Obs

United States, Canada, Scotland, Norway

Medline,

Embase,

CINAHL

Grey literature:

clinicaltrials.gov, PROSPERO,

CENTRAL

Cochrane ROBIS tool, Ottawa scale

2 high risk,

1 low,

1 some concerns, observational studies range: 2 – 9

Narrative synthesis

Malik

2018

Ireland [57]

To systematically review the impact of geriatric focused nurse assessment and intervention in the ED on hospital utilisation in terms of admission rate, ED revisits and length of hospital stay (LOHS)

SR

Adults ≥ 65

(761)

9

(1996–2015)

RCTs, PBAs

Canada, Australia, Denmark, Scotland, USA

Cochrane, Medline, CINAHL,

Embase,

Scopus,

WOS

EBL critical appraisal tool (yes/total > 75% = valid),

RevMan ROBIS tool

1 (yes) 64%,

1 (yes) 55%,

7 RCTs details: in table

Narrative synthesis &

Meta-analysis

Maninchedda 2023

Italy [72]

To identify the characteristics of the problem, analysing the proposed strategies aimed at improving patient flow, delay in services provided and overcrowding of emergency departments

SR

Patients ≥ 13

Not reported

19

(2012–2021)

Descriptive study,

Obs,

Belgium, Brazil,

USA, Canada, China,

Hong Kong, Israel,

South Africa, UK,

Taiwan, Turkey

PubMed,

Scopus,

WOS

Not appraised

Narrative synthesis

Manning 2023

Australia [29]

To uncover the challenges related to patient flow from a whole public hospital perspective and identify strategies to overcome these challenges

SR

N/A

24

(2015–2020)

Quantitative, Qualitative, Mixed method,

SR

USA,

UK, England, France, Australia, Canada, Austria, Netherlands

Emcare,

PubMed

QATSDD

(Score: 7 -37)

42 for qualitative & quantitative. 48 for a mixed method

Thematic analysis

Morley

2018

Australia [15]

To expand on and provide an updated critical analysis of the findings of peer-reviewed research studies exploring the causes or consequences of, or solutions to, ED crowding

SR

N/A

102

(2000–2018)

Cohort,

RCR,

B&A,

RCT, TS,

Obs,

Mixed methods,

Field study, nRCT,

Cross-sectional, Modelling, Observational registry,

Singapore, UK,

USA, Australia, Finland, Korea, Canada, New Zealand, Holland, Taiwan, Belgium, China, Sweden

Medline, CINAHL, EMBASE,

WOS

SIGN

59% acceptable quality,

7% high quality,

34% low quality

Narrative synthesis

Ortíz-Barrios 2020

Australia [73]

Identifying approaches to support process improvement in emergency departments

SR

N/A

203

(1993–2019)

Not reported

Not reported

WOS, IEEE,

Scopus,

PubMed,

Google Scholar,

ACM Digital Library,

Science Direct

Not appraised

Narrative review

Pearce

2023

Canada [39]

To synthesise the current literature of the causes, harms, and measures of crowding in emergency departments around the world

UR

N/A

13

(744 studies included in those reviews)

(1980–2012)

SR

Canada, USA, Brazil, Australia, Iran,

Saudi Arabia,

New Zealand, Italy

MEDLINE, Embase

JBI checklist tool

5 low,

7 moderate, 1 high

Narrative review

Preston

2017

UK [74]

To systematically map interventions to identify frail and high-risk older people in the ED and interventions to manage older people in the ED and to map the outcomes of these interventions and examine whether or not there is any evidence of the impact of these interventions on Patient and health service outcomes

SMR

Frail and high risk older people and general populations of older people (aged > 65 years)

(Not reported)

120

(2005–2016)

AR,

Audit,

B&A,

Cross-sectional,

Diagnostic accuracy,

Feasibility study,

RCR,Obs,

Pilot project,

RBAs,

Cohort study,

Comparative study,

nRCTs,QE

USA, Australia, UK,

Italy, Canada, Ireland, Switzerland, Netherlands, Singapore, Hong Kong, Spain, weden, France, Belgium, Germany, New Zealand, South Korea, Taiwan, Turkey

MEDLINE, EMBASE, Cochrane Library, WOS,

CINAHL,

Health Management Information Consortium, PROSPERO

Formal assessment not done

(Bespoke assessment)

Not reported

Narrative synthesis

Rasouli

2019

Iran [75]

To conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals

SR

N/A

106

(2007–2018)

Peer-reviewed original articles

Not reported

PubMed,

EMBASE

CASP,

JBI Meta-Analysis of Statistics Assessment and Review Instrument

No ratings reported

Narrative synthesis

Sharma

2020

UK [76]

To explore nurses' roles and their contributions to maintaining patient flow in acute hospitals through emergency departments

SR

Nurses in ED, ED patients

N/A

34

(1993–2019)

Mixed studies,

SR, QE, B&A,

Exploratory,

Ethnography,

Cross-sectional, Grounded theory,

AR, Descriptive RCT, CRT

USA,

UK,

Canada, Australia, Iran,

India,

Italy, Netherlands, Sweden

PubMed, CINHAL,

BNI,

ASSIA,

SCOPUS,

Google Scholar,

CASP

19 high quality,

11 moderate quality,

4 poor quality

Narrative synthesis

Shepherd 2022

UK [77]

To scope all radiographer-led discharge (RLD) literature and identify research assessing the merits of RLD and requirements to enable implementation

ScR

Radiographers ED patients with minor MSK injuries of the extremities

7

(2007–2018)

Audit,

Pilot studies, Simulation modelling study, feasibility study,

survey, mixed methods study

UK

MEDLINE, Embase,

CINAHL,

Scopus,

Google Scholar,

Radiography journal,

Public Health England sources, Imaging and Therapy in Practice magazine, University of Exeter Repository

Not appraised

Narrative synthesis/

Descriptive-analytical approach

Voaklander 2022

Canada [78]

To describe and evaluate the effectiveness of interventions to improve the ED consultation process

SR

Patients presenting to ED

Not reported for all studies

35

(2004–2021)

B&A,

CBAs,

RCT,

Cohort

TS

USA, Canada, South Korea, Singapore, Thailand, Taiwan, India, Ireland, Turkey

OVID,

PubMed,

EMBASE, SCOPUS,

Dissertation & Theses Global, EBM Reviews/

Cochrane Library,

Global Health OVID,

CINAHL EBSCOhost, Google scholar,

Emergency Medicine Journals

MINORS

All included studies was

considered poor

Narrative synthesis & meta-analysis

Zepeda-Lugo 2020

Mexico [79]

To evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve

SR

N/A

39

(2002–2019)

RCTs,

CBAs,

QE,

Case‒control, Cohort,

B&A

USA, Taiwan, Spain,

UK,

Saudi Arabia, Italy,

India, Netherlands, Lebanon

PubMed, CINAHL,

Cochrane Library,

WOS, Scopus, Ebsco

ProQuest,

OpenGrey,

Google Scholar

Cochrane's ROBINS-I

72% moderate,

28% serious risk of bias

Narrative review