Acute Care Diagnostics and Emergency Triage Workflows: A Systematic Review of Interprofessional Coordination Among Emergency Consultants, Laboratory Specialists, and Patient Care Technicians
DOI:
https://doi.org/10.65759/eff2d120Abstract
Background: Emergency department flow depends on rapid assessment, diagnostic testing, specimen handling, and coordinated transfer of information in professional roles. Fragmentation between emergency clinicians, laboratory personnel, and technical support staff creates avoidable delays across the diagnostic pathway. Objective: This review synthesized data on acute-care triage and diagnostic workflows that redistribute tasks or integrate emergency consultants, laboratory services, phlebotomy or technical assistants, and point-of-care testing. Methods: The review was structured according to PRISMA 2020. PubMed/MEDLINE and the Cochrane Library were searched directly through 9 August 2024, with equivalent Scopus and Web of Science concept blocks prespecified for database-native verification. Eligible original studies evaluated emergency department workflow interventions and reported waiting time, length of stay, laboratory turnaround time, time to result, or incomplete visits. Results: We include ten original studies in this synthesis. Senior clinician involvement at triage consistently shortened time to initial assessment, while effects on total length of stay varied with downstream diagnostic demand. Dedicated phlebotomy and technical-assistant models improved selected waiting-time, specimen-quality, and incomplete-visit outcomes. Point-of-care testing markedly reduced analytical turnaround time, with smaller and less consistent effects on total emergency department stay. Conclusion: Effective acute-care diagnostics depend on coordination across the entire testing pathway rather than isolated acceleration of one step. Workflow redesign is strongest when roles, escalation routes, specimen ownership, test governance, and result communication are explicitly defined.
References
1. Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One. 2018;13(8):e0203316. doi:10.1371/journal.pone.0203316.
2. Andersson J, Nordgren L, Cheng I, Nilsson U, Kurland L. Long emergency department length of stay: A concept analysis. Int Emerg Nurs. 2020;53:100930. doi:10.1016/j.ienj.2020.100930.
3. Youssef E, Benabbas R, Choe B, Doukas D, Taitt HA, Verma R, et al. Interventions to improve emergency department throughput and care delivery indicators: A systematic review and meta-analysis. Acad Emerg Med. 2024;31(8):789-804. doi:10.1111/acem.14946.
4. Benabbas R, Shah R, Zonnoor B, Mehta N, Sinert R. Impact of triage liaison provider on emergency department throughput: A systematic review and meta-analysis. Am J Emerg Med. 2020;38(8):1662-1670. doi:10.1016/j.ajem.2020.04.068.
5. Gottlieb M, Farcy DA, Moreno LA, Vilke GM, Guittard JA. Triage nurse-ordered testing in the emergency department setting: A review of the literature for the clinician. J Emerg Med. 2021;60(4):570-575. doi:10.1016/j.jemermed.2020.11.004.
6. Hawkins RC. Laboratory turnaround time. Clin Biochem Rev. 2007;28(4):179-194.
7. Sharma S, Rafferty AM, Boiko O. The role and contribution of nurses to patient flow management in acute hospitals: A systematic review of mixed methods studies. Int J Nurs Stud. 2020;110:103709. doi:10.1016/j.ijnurstu.2020.103709.
8. Gonçalves-Bradley DC, Khangura JK, Flodgren G, Perera R, Rowe BH, Shepperd S. Primary care professionals providing non-urgent care in hospital emergency departments. Cochrane Database Syst Rev. 2018;2(2):CD002097. doi:10.1002/14651858.CD002097.pub4.
9. Holroyd BR, Bullard MJ, Latoszek K, Gordon D, Allen S, Tam S, et al. Impact of a triage liaison physician on emergency department overcrowding and throughput: A randomized controlled trial. Acad Emerg Med. 2007;14(8):702-708. doi:10.1197/j.aem.2007.04.018.
10. Lauks J, Mramor B, Baumgartl K, Maier H, Nickel CH, Bingisser R. Medical Team Evaluation: Effect on emergency department waiting time and length of stay. PLoS One. 2016;11(4):e0154372. doi:10.1371/journal.pone.0154372.
11. Liu J, Masiello I, Ponzer S, Farrokhnia N. Interprofessional teamwork versus fast track streaming in an emergency department—An observational cohort study of two strategies for enhancing the throughput of orthopedic patients presenting limb injuries or back pain. PLoS One. 2019;14(7):e0220011. doi:10.1371/journal.pone.0220011.
12. Grouse A, Bishop R. Non-medical technicians reduce emergency department waiting times. Emerg Med (Fremantle). 2001;13(1):66-69. doi:10.1046/j.1442-2024.2001.00181.x.
13. Dinh MM, Green TC, Newsome D, Bein KJ. Impact of technical assistants for venepuncture and intravenous cannulation on overall emergency department performance. Emerg Med Australas. 2011;23(6):726-731. doi:10.1111/j.1742-6723.2011.01479.x.
14. Sheppard C, Franks N, Nolte F, Fantz C. Improving quality of patient care in an emergency department: A laboratory perspective. Am J Clin Pathol. 2008;130(4):573-577. doi:10.1309/DGXYTH0VNTTQRQHD.
15. Stowell JR, Pugsley P, Jordan H, Akhter M. Impact of emergency department phlebotomists on left-before-treatment-completion rates. West J Emerg Med. 2019;20(4):681-687. doi:10.5811/westjem.2019.5.41736.
16. Murray RP, Leroux M, Sabga E, Palatnick W, Ludwig L. Effect of point of care testing on length of stay in an adult emergency department. J Emerg Med. 1999;17(5):811-814. doi:10.1016/S0736-4679(99)00107-9.
17. Hausfater P, Hajage D, Bulsei J, Canavaggio P, Lafourcade A, Paquet AL, et al. Impact of point-of-care testing on length of stay of patients in the emergency department: A cluster-randomized controlled study. Acad Emerg Med. 2020;27(10):974-983. doi:10.1111/acem.14072.
18. Vrijsen BEL, Haitjema S, Westerink J, Hulsbergen-Veelken CAR, van Solinge WW, Ten Berg MJ. Shorter laboratory turnaround time is associated with shorter emergency department length of stay: A retrospective cohort study. BMC Emerg Med. 2022;22(1):207. doi:10.1186/s12873-022-00763-w.
19. Devia Jaramillo G, Esmeral Zuluaga N, Velandia Avellaneda VA. Effective strategies for reducing patient length of stay in the emergency department: A systematic review and meta-analysis. BMC Emerg Med. 2024;25:25. doi:10.1186/s12873-024-01163-y.
20. Ayenew T, Gedfew M, Fetene MG, Telayneh AT, Adane F, Amlak BT, et al. Prolonged length of stay and associated factors among emergency department patients in Ethiopia: Systematic review and meta-analysis. BMC Emerg Med. 2024;24(1):212. doi:10.1186/s12873-024-01131-6.
21. Rowe BH, Guo X, Villa-Roel C, Schull M, Holroyd B, Bullard M, et al. The role of triage liaison physicians on mitigating overcrowding in emergency departments: A systematic review. Acad Emerg Med. 2011;18(2):111-120. doi:10.1111/j.1553-2712.2010.00984.x.
22. Kilner E, Sheppard LA. The role of teamwork and communication in the emergency department: A systematic review. Int Emerg Nurs. 2010;18(3):127-137. doi:10.1016/j.ienj.2009.05.006.
23. Gilardi S, Guglielmetti C, Pravettoni G. Interprofessional team dynamics and information flow management in emergency departments. J Adv Nurs. 2014;70(6):1299-1309. doi:10.1111/jan.12284.
24. Boiko O, Edwards M, Zschaler S, Miles S, Rafferty AM. Interprofessional barriers in patient flow management: An interview study of the views of emergency department staff involved in patient admissions. J Interprof Care. 2021;35(3):334-342. doi:10.1080/13561820.2020.1760223.
