Ítem
Acceso Abierto
Estrategias que reducen el tiempo de estancia del paciente en la sala de urgencias, revisión sistemática y metaanálisis
Título de la revista
Autores
Velandia Avellaneda, Viviana Andrea
Esmeral Zuluaga, Nathalia María
Fecha
2025-05-06
Directores
Devia Jaramillo, Germán Alberto
ISSN de la revista
Título del volumen
Editor
Universidad del Rosario
Buscar en:
Métricas alternativas
Resumen
El sobrecupo es una condición frecuente en las salas de urgencias, el cual puede estar relacionado con la prolongación del tiempo de estancia de los pacientes en el servicio. En la literatura existen muchas estrategias reportadas con el fin de reducir los EDLOS, sin embargo, no hay claridad en cuáles de estas estrategias son efectivas para la reducción del tiempo de estancia de los pacientes. Basado en esta afirmación, surge la necesidad de establecer cuáles de las estrategias reportadas logran reducir los EDLOS de forma significativa y de esta forma contribuir a la disminución de sobrecupo en las salas de urgencias.
Abstract
Background Overcrowding is a common issue in emergency departments worldwide. One condition associated with overcrowding is the Emergency Department Length of Stay(EDLOS). Prolonged EDLOS is linked to increased hospitalization costs, worsening clinical outcomes, and deterioration in patient-reported outcomes. Consequently, there is a need to reduce EDLOS, and the scientific literature reports multiple strategies aimed at this goal. Therefore, the objective of this study was to determine strategies statistically significant in reducing the EDLOS. Method A systematic search was conducted in PubMed, Scopus, the Latin American and Caribbean Health Sciences Literature (LILACS) database, and Google Scholar from January 2000 to January 2024. Studies that included patient care strategies in emergency departments to reduce EDLOS, in adults or pediatric populations, and observational or experimental studies were included. The quality of the studies was assessed using the Cochrane Collaboration’s Risk of Bias tool for Interventional Studies, and the certainty of the evidence was evaluated using the Grading of Recom- mendations Assessment, Development, and Evaluation criteria. A mean difference analysis in minutes was performed using a random-effects model. Results A total of 3410 studies were identified using the search strategy with a total of 245,404 patients were ana- lyzed. Three types of strategies were identified with results in reducing EDLOS. Interventions performed by physicians in the triage area (liaison, supervision, and advanced triage) showed a significant reduction of -21.87 min (95% CI -28.35; -15.38). The second intervention was the use of Point-of-Care Testing, which showed a reduction of -41.98 min (95% CI -98.13; 14.15). The third intervention was the creation of fast-track strategies, which documented a reduction of -21.81 min (95% CI -41.79; -1.83). Most of the studies were of the before-and-after type. The certainty of the evi- dence for the first intervention was moderate, while for the other two groups, it was considered low. Conclusion The presence of a physician in the triage team demonstrated a reduction in patient EDLOS, although with high heterogeneity among the analyzed studies. Similarly, the use of fast-track strategies is also signifi- cantly useful in reducing EDLOS, while POCT reduces EDLOS but not significantly.
Palabras clave
Servicios de emergencias , Tiempo de estancia , Triage , Unidades de atención rapida , Pruebas en el punto de atención
Keywords
Emergency services , Length of stay , Triage , Fast-track , POCT
