ArticleInternational journal of emergency medicine2019
The impact of a multimodal intervention on emergency department crowding and patient flow.
Article in International journal of emergency medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Interventions to reduce emergency department overcrowding and their effects on patient outcomes: a mixed-methods systematic review and meta-analysis.BMC emergency medicine · 2026Pooled it
- Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review.International journal of environmental research and public health · 2020Pooled it
- Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review.International journal of environmental research and public health · 2020Pooled it
- Usefulness of Protocolized Point-of-Care Ultrasonography for Patients with Acute Renal Colic Who Visited Emergency Department: A Randomized Controlled Study.Medicina (Kaunas, Lithuania) · 2019Trial
- Overcrowding Indicators in Emergency Departments Across Countries: Scoping Review.Interactive journal of medical research · 2026Review
- Characteristics of emergency department visits in Jordanian public hospitals.International journal of emergency medicine · 2025Article
- Prolonged length of stay and its associated factors at adult emergency department in amhara region comprehensive specialized hospitals, northwest Ethiopia.BMC emergency medicine · 2023Article
- Effects of process changes on emergency department crowding in a changing world: an interrupted time-series analysis.International journal of emergency medicine · 2023Article
- The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial.World journal of emergency medicine · 2023Article
- Patterns in emergency department unscheduled return visits during the COVID-19 pandemic.The American journal of emergency medicine · 2022Article
- The Influence of Saudi National COVID-19 Preparedness Programs on Triage Decision-Making Skills of Healthcare Practitioners During the 2020 Peak of the 1st Wave of COVID-19.Infection and drug resistance · 2022Article
- A Systematic Review on Lean Applications' in Emergency Departments.Healthcare (Basel, Switzerland) · 2021Review
- Increasing consultant-level staffing as a proportion of overall physician coverage improves emergency department length of stay targets.BMC emergency medicine · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe objective of this study is to assess the impact of a multimodal intervention on emergency department (ED) crowding and patient flow in a Dutch level 1 trauma center.
methodsIn this cross-sectional study, we compare ED crowding and patient flow between a 9-month pre-intervention period and a 9-month intervention period, during peak hours and overall (24/7). The multimodal intervention included (1) adding an emergency nurse practitioner (ENP) and (2) five medical specialists during peak hours to the 24/7 available emergency physicians (EPs), (3) a Lean programme to improve radiology turnaround times, and (4) extending the admission offices' openings hours. Crowding is measured with the modified National ED OverCrowding Score (mNEDOCS). Furthermore, radiology turnaround times, patients' length of stay (LOS), proportion of patients leaving without being seen (LWBS) by a medical provider, and unscheduled representations are assessed.
resultsThe number of ED visits were grossly similar in the two periods during peak hours (15,558 ED visits in the pre-intervention period and 15,550 in the intervention period) and overall (31,891 ED visits in the pre-intervention period vs. 32,121 in the intervention period). During peak hours, ED crowding fell from 18.6% (pre-intervention period) to 3.5% (intervention period), radiology turnaround times decreased from an average of 91 min (interquartile range 45-256 min) to 50 min (IQR 30-106 min., p < 0.001) and LOS reduced with 13 min per patient from 167 to 154 min (p < 0.001). For surgery, neurology and cardiology patients, LOS reduced significantly (with 17 min, 25 min, and 8 min. respectively), while not changing for internal medicine patients. Overall, crowding, radiology turnaround times and LOS also decreased. Less patients LWBS in the intervention period (270 patients vs. 348 patients, p < 0.001) and less patients represented unscheduled within 1 week after the initial ED visit: 864 (2.7%) in the pre-intervention period vs. 645 (2.0%) patients in the intervention period, p < 0.001.
conclusionsIn this hospital, a multimodal intervention successfully reduces crowding, radiology turnaround times, patients' LOS, number of patients LWBS and the number of unscheduled return visits, suggesting improved ED processes. Further research is required on total costs of care and long-term effects.
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