A scoping review of work system elements that influence emergency department disposition decision-making
Rachel A. Rutkowski, Eleanore Scheer, Claire Carlson, Reid Parks, Michael S. Pulia, Brian W. Patterson, Manish N. Shah, Peter Hoonakker, Pascale Carayon, Maureen A. Smith, Leslie Christensen, Nicole E. Werner
Abstract
Emergency department (ED) disposition decision-making represents a critical juncture in patients’ care journeys, as it shapes the type of care patients access following an ED visit. However, there is a dearth of information related to how and in what context the disposition decision-making occurs. We conducted a scoping review to synthesize what previous studies reveal about the ED work system elements that influence disposition decision-making. A dual-coding screening process identified 27 articles from database searches. Articles were extracted and analyzed using the Systems Engineering Initiative for Patient Safety model. Most articles included at least two work system components. Our results suggest that the literature captures only some of the complexity of disposition decision-making, leaving certain elements underexplored or limited in scope. This review identifies informational gaps that, if addressed by future research, will support ED system redesigns that optimize patient, clinician, and organizational outcomes.