BACKGROUND The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions. METHODS Six major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects. RESULTS Of the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician. CONCLUSION Inter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention's effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures. TRIAL REGISTRATION The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).

中文翻译：

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缓解老年人急诊科拥挤的干预措施的有效性：系统评价。


背景技术对老年人护理不断增长的需求往往超出了急诊科（ED）服务在合理时间内提供优质护理的能力。本系统评价的目的是评估干预措施在减少老年患者急诊拥挤方面的有效性，并确定成功干预措施所共有的核心特征。方法 检索六个主要生物医学数据库，查找 1990 年 1 月至 2017 年 3 月期间发表的（准）实验研究，评估老年患者干预措施对 ED 拥挤相关结局的影响。两名独立评审员筛选和选择研究，评估偏倚风险并将数据提取为标准化形式。围绕研究背景、设计、质量、干预内容、结果类型和观察到的效果综合了数据。结果 在纳入的 16 项研究中，8 项 (50%) 为随机对照试验 (RCT)，2 项 (13%) 为非 RCT，6 项 (34%) 为前后对照 (CBA) 研究。十三项研究 (81%) 评估了对 ED 复诊的影响，四项研究 (25%) 评估了对 ED 处理时间的影响。十三项研究 (81%) 描述了多成分干预措施。特定急诊室的专职工作人员根据时间效率目标对老年人进行快速评估和分流护理，导致急诊住院时间 (LOS) 在统计上显着减少。与深入的老年科医生相比，急诊科的老年科医生顾问显示患者入院和老年病复查之间的时间显着缩短。结论 研究间的异质性和较差的方法质量阻碍了就干预措施在减少老年人急诊室拥挤方面的有效性得出明确的结论。 需要使用统一且有效的效果衡量标准进行更多基于证据的研究。试验注册 该方案已在 PROSPERO 国际系统评价登记册中注册：ID = CRD42017075575）。