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Objectives: Emergency department (ED) consultations with specialists are necessary for safe and effective patient care. Delays in the ED consultation process, however, have been shown to increase ED length of stay (LOS) and contribute to ED crowding. This review aims to describe and evaluate the effectiveness of interventions to improve the ED consultation process., Methods: Eight primary literature databases and the gray literature were searched to identify comparative studies assessing ED-based interventions to improve the specialist consultation process. Two independent reviewers identified eligible studies, assessed study quality, and extracted data. Individual or pooled meta-analysis for continuous outcomes were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model was conducted., Results: Thirty-five unique comparative intervention studies were included. While the interventions varied, four common components/themes were identified including interventions to improve consultant responsiveness (n = 11), improve access to consultants in the ED (n = 9), expedite ED consultations (n = 8), and bypass ED consultations (n = 7). Studies on interventions to improve consult responsiveness consistently reported a decrease in consult response times in the intervention group with percent changes between 10% and 71%. Studies implementing interventions to improve consult responsiveness (MD -2.55, 95% CI -4.88 to -0.22) and interventions to bypass ED consultations (MD -0.99, 95% CI -1.43 to -0.56) consistently reported a decrease in ED LOS; however, heterogeneity was high (I 2  = 99%). Evidence on whether any of the interventions were effective at reducing the proportion of patients consulted or subsequently admitted varied., Conclusions: The various interventions impacting the consultation process were predominately successful in reducing ED LOS, with evidence suggesting that interventions improving consult responsiveness and improving access to consultants in the ED also improve consult response times. Health care providers looking to implement interventions to improve the ED consultation process should identify key areas in their setting that could be targeted., (© 2022 Society for Academic Emergency Medicine.)

The present system for referral of clients, particularly the elderly, to health care and social services providers is often fragmented, slowed by inaccurate or incomplete client information, and therefore less effective and perhaps more costly than it needs to be. A New York demonstration project is currently developing a computer-based information and referral system designed to streamline the referral process, provide client data to multiple agencies with only one admission interview, and offer instant access to selected agency data. Eighteen agencies are involved in the initial 2-year project; others will be invited to join once the system has been refined. Among the issues being addressed as the group creates the Community Information and Referral Access System (CIRAS) are client confidentiality, informed consent, participation guidelines, referral processes, and service definitions.