1 Di Laura D, et al. BMJ Open Quality 2021;10:e001058. doi:10.1136/bmjoq-2020-001058 Open access Effciency measures of emergency departments: an Italian systematic literature review Danilo Di Laura, 1 Lucia D'Angiolella, 1 Lorenzo Mantovani, 1 Ginevra Squassabia, 1 Francesco Clemente, 1 Ida Santalucia, 2 Giovanni Improta , 2,3 Maria Triassi 2,3 To cite: Di Laura D, D'Angiolella L, Mantovani L, et al. Effciency measures of emergency departments: an Italian systematic literature review. BMJ Open Quality 2021;10:e001058. doi:10.1136/ bmjoq-2020-001058 ► Additional supplemental material is published online only. To view, please visit the journal online (http://dx.doi.org/10. 1136/bmjoq-2020-001058). GI and MT contributed equally. Received 13 June 2020 Accepted 16 August 2021 1 Department of Public Health, Università degli Studi di Milano- Bicocca, Monza, Lombardia, Italy 2 Department of Public Health, Universita degli Studi di Napoli Federico II, Napoli, Italy 3 Interdepartmental Center for Research in Health Management and Innovation in Health (CIRMIS), Università degli studi di Napoli Federico II, Napoli, Italy Correspondence to Dr Giovanni Improta; ing.improta@gmail.com Systematic review © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Life expectancy globally increased in the last decades: the number of people aged 65 or older is consequently projected to grow, and healthcare demand will increase as well. In the recent years, the number of patients visiting the hospital emergency departments (EDs) rocked in almost all countries of the world. These departments are crucial in all healthcare systems and play a critical role in providing an effcient assistance to all patients. A systematic literature review covering PubMed, Scopus and the Cochrane Library was performed from 2009 to 2019. Of the 718 references found in the literature research, more than 25 studies were included in the current review. Different predictors were associated with the quality of EDs care, which may help to defne and implement preventive strategies in the near future. There is no harmonisation in effciency measurements refecting the performance in the ED setting. The identifcation of consistent measures of effciency is crucial to build an evidence base for future initiatives. The aim of this study is to review the literature on the problems encountered in the effciency of EDs around the world in order to identify an organisational model or guidelines that can be implemented in EDs to fll ineffciencies and ensure access optimal treatment both in terms of resources and timing. This review will support policy makers to improve the quality of health facilities, and, consequently of the entire healthcare systems. INTRODUCTION Worldwide, in the last 150 years, human life expectancy has rapidly increased, doubling from around 45 years to 80 years, in many industrialised countries. Driven by increases in life expectancy, the world’s population is ageing, and this growth is projected to accel- erate in the coming decades. The number of people aged 65 or older, accounts for 21% of the global population; however, over the next 30 years, the number of older persons is projected to increase to 33%, in 2050 (WHO, ISTAT Geodemo—2017). These extra years of life and demographic shifts have profound implications for health systems and the soci- eties in general, since ageing is a well‐estab- lished risk factor also for the development of several multiple chronic diseases, including cardiovascular disease, stroke, cancer, oste- oarticular and neurological diseases. The exponential increase of chronical disease due to the ageing world population leaded conse- quently to increase of healthcare demand. Older people generally have more complex problems, requiring more investigations, admissions and critical care. It is also worth noting that elderly patients have considerable comorbidities, seem increasingly to be sent to emergency departments (EDs). In the recent years, the number of patients visiting the hospital EDs rocked in almost all countries of the world. These departments are crucial in all healthcare systems and play a critical role in providing an efficient assistance to all patients, especially for elderly with chronic and multichronic conditions. Inefficiency EDs are an ongoing issue for hospital staff, healthcare administrators, policy makers and patients. With increasing patient demands on these services and constricting budgets, administrators are in search of practical and implementable solutions to optimise patient flow and increase throughput. 1 Over the last decades, the role of EDs has evolved and EDs have become providers of not only acute emergency services, but also of care for patients needing in general, of primary healthcare, 2 trying always to provide an efficient and quality service to all patients. 3 The increase in our ageing population pres- ents many opportunities and several public health challenges that we need to prepare for. The most important challenge for healthcare systems is to provide assistance, improving efficiency, productivity, and the appropriate- ness and quality of care and its departments and for this aim, various tools and approaches have been proposed in the literature so far in different healthcare settings and for different objectives aimed at improving the quality of the provided services. 4–9 However, no objec- tive and officially parameters that can assess the true efficiency and quality of these EDs copyright. on February 25, 2022 by guest. Protected by http://bmjopenquality.bmj.com/ BMJ Open Qual: first published as 10.1136/bmjoq-2020-001058 on 7 September 2021. Downloaded from