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J Korean Soc Emerg Med > Volume 29(2); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(2): 170-178.
응급실 체류시간 제한이 과밀화 및 진료의 질에 미치는 영향: 체계적 문헌고찰과 메타분석
윤병석1 , 좌민홍1 , 공태영1 , 주영선1, 고동률1 , 황윤정1, 박인철1, 정성필1* , 이혜선2
1연세대학교 의과대학 응급의학교실
2연세대학교 의과대학 연구부 통계지원팀
The effect of time target on overcrowding and clinical quality in the ED: a systematic review and meta-analysis
Byoung Seok Yoon1 , Min Hong Choa1 , Tae Young Kong1 , Young Seon Joo1, Dong Ryul Ko1 , Yoon Jung Hwang1, In Cheol Park1, Sung Phil Chung1* , Hye Sun Lee2
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Sung Phil Chung ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: emstar@yuhs.ac,
Received: November 2, 2017; Revised: December 29, 2017   Accepted: December 29, 2017.  Published online: April 30, 2018.
Many studies have reported the effectiveness of the ‘time target’ on reducing emergency department (ED) overcrowding and improving clinical quality. This study examined the effects of introducing the time target on ED overcrowding and clinical quality using meta-analysis.
The electronic databases including PubMed (Medline), Cochrane Library, and Embase until June 2017 were searched. The search keywords were ‘time target,’ ‘national emergency access target,’ ‘four-hour rule,’ and ‘shorter stays in ED’. Two investigators selected and reviewed articles according to the predefined inclusion and exclusion criteria. The quality of the articles was evaluated using the RoBANS checklist. The data were abstracted by predetermined criteria and meta-analysis was performed using RevMan software.
Of 721 articles, 16 studies were included in the final analysis. A meta-analysis of four studies on the ED length of stay (LOS) showed that the mean EDLOS was reduced by 0.64 hours (95% confidence interval [CI], 0.34-0.94) since the introduction of the time target. Other studies also showed that the EDLOS was reduced. There was no definite trend in the hospital admission rate. Meta-analysis of nine studies on the clinical quality revealed a total odds ratio of 1.02 (95% CI, 0.74-1.32). Time taken until the visitation of a doctor and the initiation of treatment were both reduced. The rate of “left without being seen” was decreased.
EDLOS was reduced and no significant association was observed between mortality and the application of a time target since the introduction of time target. ‘Rate of revisiting,’ ‘time to clinician,’ ‘time to treatment,’ and ‘rate of left without being seen’ was reduced.
Key words: Healthcare quality indicators; Crowding; Emergency department
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