Date of Conferral

8-2-2025

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Miriam Ross

Abstract

Leaders of the emergency departments (EDs) globally, especially in the United States face persistent challenges addressing staffing issues in the ED and increased wait times. The purpose and review question for this integrative review was to investigate strategies and best practices to decrease waiting times in a hospital ED. The Theory of Constraints framework served as the theoretical foundation for this review. An examination of the literature published within the past five years identified 101 relevant articles. From these articles, 30 empirical and non-empirical articles were selected for further analysis using the Johns Hopkins evidence-based practice model and six major themes and twelve sub-themes emerged. The six themes were (a) bottleneck identification and management, (b) implementation of early discharge strategies, (c) process optimization through fast-track systems, (d) maximize resource management, (e) expand technology integration, and (f) increase staffing and education. Twelve subthemes were identified, with the most significant being root cause analysis, bed management, load distribution, patient-centered approaches, dedicated EMS triage, process redesign, and resource allocation. This integrative review highlighted effective strategies for reducing emergency department wait times. Importantly, addressing social determinants of health (SDoH) is increasingly acknowledged as an essential approach, as it targets underlying factors contributing to frequent and prolonged use of emergency services. Through the adoption of evidence-based recommendations, healthcare organizations can cultivate a resilient, high-performing workforce dedicated to quality care and the advancement of meaningful, sustainable social change.

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