Care of patients in emergency department waiting rooms: an integrative review

Abstract

Aim. To conduct an integrative review of primary research examining patient care roles introduced into emergency department waiting rooms. Background. Internationally, emergency departments are under pressure to meet increasing patient demand with limited resources. Several initiatives have been developed that incorporate a healthcare role in waiting rooms, to assess and initiate early interventions to decrease waiting times, detect patient deterioration and improve communication. The literature reporting these roles has not been systematically evaluated. Design. Integrative review. Data sources. Published English-language peer reviewed articles in CINAHL, Scopus, Medline and Web of Knowledge between 2003-2014. Review methods. Identified literature was evaluated using an integrative review framework, incorporating methodological critique and narrative synthesis of findings. Results. Six papers were included, with three waiting room roles identified internationally - clinical initiative nurse, Physician-Nurse Supplementary Assessment Team and clinical assistants. All roles varied in terms of definitions, scope, responsibilities and skill sets of individuals in the position. There was limited evidence that the roles decreased waiting times or improved patient care, especially during busy periods. Of note, staff members performing these roles require high-level therapeutic relationship and effective interpersonal skills with patients, family and staff. The role requires support from other staff, particularly during periods of high workload, for optimal functioning and effective patient care. Conclusion. Generalisations and practice recommendations are limited due to the lack of available literature. Further research is required to evaluate the impact emergency department waiting room roles have on patient outcomes and staff perspectives.