Can applying process modelling techniques in an Emergency department improve the efficiency and quality of care provided? : A Systematic Review

Abstract

Background: The goal of all Healthcare systems is to always provide the best quality of care while sustaining similar costs. Process mapping is one of the quality improvement techniques that has proven its effectiveness in the business sector. The focus of this review is the application of process modelling techniques in the Emergency Department which is faced with many challenges. A published study observed the occurrence of higher number of preventable medical errors during the peaks of crowdedness in the ED. Aim: The aim of this systematic review, is to provide synthesis of the available literature to evaluate the impact of the different available process mapping techniques and determine their effect on the effectiveness and efficiency of the emergency department services. Methods: A comprehensive literature search was carried out using four different databases (Medline-Ovid, HMIC, Cochrane and Web of Science) to identify eligible studies, besides reviewing the reference list and citation search of the included studies. Data were extracted from all identified literature followed by quality assessment using SQUIRE2.0 Checklist. A narrative synthesis approach was undertaken as it is suitable to report quantitative and qualitative studies as well as its suitability to synthesize reports assessing the effectiveness of an intervention. In addition to overcoming the effect of the expected sources of heterogeneity. Results: Searching the databases resulted in 113 studies, additional 35 were identified through searching the web and reviewing the reference list and citation search. Duplicates were removed and titles and abstracts were reviewed for eligibility. After that, 25 full texts were reviewed and 8 were included in this review where 15 different outcomes were measured. Results of the included studies have shown significant improvement in (LOS, waiting times and patient satisfaction) and no change in other outcomes (LWBS, mortality rates ..). Discussion and Conclusion: In the light of the results obtained from this review, the process mapping methodologies evaluated appears to have a promising positive impact on the effectiveness and efficiency of the services provided in the ED by offering important and remarkable opportunities of improvements. However, the real effects of these interventions depend on how the study teams and study sites personnel understand, assess and implement the changes that the intervention would help them identify