The Impact of Process Mapping Techniques on Emergency Department Efficiency and Quality of Care: A Systematic Review

Abstract

Abstract Background: Emergency departments worldwide face operational challenges that impact patient care quality and efficiency. Process mapping techniques have emerged as potential quality improvement strategies, yet comprehensive evidence of their effectiveness in emergency department settings remains limited. Objective: To systematically review the impact of process mapping techniques on emergency department efficiency and quality of care. Methods: Article search was conducted at five databases (PubMed, Web of Science, Scopus, MEDLINE, ACM) from August 2024 to January 2025, with no date restrictions. Studies were included if they explicitly applied process mapping techniques in emergency department settings and reported efficiency or quality outcomes. Two reviewers independently screened studies and extracted data. Study quality was assessed using the SQUIRE 2.0 checklist. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was conducted. Results: Twenty-four studies met inclusion criteria, representing diverse settings across 12 countries. All studies reported positive efficiency outcomes, with process mapping techniques demonstrating median reductions of 20% in emergency department length of stay (range: 3-68%) and 54% in door-to-doctor wait times (range: 29-78%). Left without being seen (LWBS) rates decreased by an average of 46% in seven of eight studies, with one study reporting a slight, nonsignificant increase. Quality of care indicators showed improvements in patient satisfaction in all three studies measuring this outcome, with no studies reporting negative impacts on clinical safety measures. Value Stream Mapping, simulation-enhanced approaches, and comprehensive Lean methodologies demonstrated the most substantial improvements across multiple domains. Conclusions: Process mapping techniques consistently improve emergency department efficiency without compromising quality of care across diverse healthcare settings. The evidence strongly supports adopting these techniques as effective quality improvement strategies, particularly for departments facing operational challenges. Future research should focus on comparative effectiveness studies and long-term sustainability evaluations.