Optimising emergency department services : evidence-based interventions to reduce clinical risk

Abstract

Introduction: Overcrowding in hospital emergency departments is one of the most pressing threats to patient safety in acute care settings worldwide. It contributes to delayed assessments, prolonged patient stays, diagnostic bottlenecks, and an increased risk of preventable harm. A structured literature search was conducted to support strategic decision-making. Methodology: A Critically Appraised Topic was conducted across the Cochrane Database of Systematic Reviews, MEDLINE and Scopus. The review focused on identifying and evaluating high-level evidence from systematic reviews and meta-analyses published between 2015 and 2025. Studies were included if they assessed the effectiveness of interventions aimed at improving service delivery at the emergency department, including patient flow, length of stay, reduction of crowding, and safety-related outcomes. The studies were synthesised to inform evidence-based recommendations. Results: A total of twelve systematic reviews and meta-analyses met the inclusion criteria. The evidence consistently supported physician-led triage and fast-track systems as impactful interventions, demonstrating reductions in patient length of stay and marked improvements in the proportion of patients leaving before being seen. Point-of-care testing, particularly when embedded within structured triage models, improves diagnostic turnaround, and facilitates earlier decisions regarding patient care. Digital tools, including real-time clinical dashboards, electronic tracking systems, and mobile communication platforms, were associated with improvements in time to patient disposition and enhanced coordination among clinical teams. Workforce-related strategies, such as expanded nursing roles, early involvement of senior clinicians, and the integration of primary care professionals, contributed to more efficient patient streaming and reductions in unnecessary investigations. Transitional care pathways and in-reach palliative care services demonstrated system-wide benefits in patient flow and discharge planning, although the impact varied depending on the specific context and implementation design. Conclusions: This synthesis demonstrated that high-performing emergency departments do not rely on isolated interventions. Instead, they adopt a systems-level approach that combines clinical redesign, digital innovation, and optimisation of human resources. Recommendations: For healthcare systems facing capacity pressures, this body of evidence supports the phased adoption of physician-led triage models. Establishing real-time operational monitoring and structured discharge planning processes are additional levers to improve both safety and efficiency. However, the findings should be interpreted considering certain limitations, including reliance on secondary sources with variable methodological quality and limited generalisability to specific healthcare systems.