Medicinal, Psychological, and Health Research Journal (MPHRJ)

A Systematic Review and Meta Analysis: Impact of Emergency Department Nursing Interventions on Patient Safety and Clinical Outcomes:

Document Type : Systematic Review

Author

Fatemeh Karami

Instructor, Department of Nursing, Ilam University of Medical Sciences, Ilam, Iran MSc in Emergency Nursing, Tehran University of Medical Sciences, Tehran, Iran

10.22034/mphrj.2026.585042.1089
Abstract
Background: Emergency departments (EDs) represent high-acuity, high-volume environments where nursing interventions critically influence patient safety and clinical outcomes. Despite the central role of emergency nurses, the aggregate evidence supporting specific nursing interventions remains fragmented.

Objective: This systematic review and meta-analysis evaluates the effectiveness of ED nursing interventions on patient safety indicators and clinical outcomes, including infection rates, medication administration safety, pain management efficiency, waiting times, and hospital readmission rates.

Methods: Following PRISMA guidelines, we systematically searched PubMed, Cochrane Library, Scopus, Web of Science, and CINAHL from inception to May 2026. Randomized controlled trials, quasi-experimental studies, and observational studies evaluating nurse-led interventions in ED settings were included. A random-effects meta-analysis conducted using Stata 16.0. Heterogeneity was assessed using I² statistics, and publication bias evaluated via funnel plots and Egger's test.

Results: Twenty-nine studies (N=12,847 patients) met inclusion criteria. Nursing interventions significantly reduced healthcare-associated infections (OR=0.69, 95% CI: 0.65-0.74, p<0.001), medication administration errors (RR=0.58, 95% CI: 0.47-0.71, p<0.001), and time-to-analgesia administration (SMD=-1.24, 95% CI: -1.67 to -0.81, p<0.001). Emergency department length of stay was reduced by approximately 25 minutes (95% CI: -32.4 to -17.6, p<0.001). Hand hygiene protocols demonstrated the greatest infection reduction efficacy (OR=0.62, 95% CI: 0.57-0.68).

Conclusions: Emergency department nursing interventions substantially improve patient safety and clinical outcomes across multiple domains. Standardizing evidence-based nursing protocols, particularly for infection control and medication administration represents a high-yield strategy for enhancing emergency care quality.

Graphical Abstract

A Systematic Review and Meta Analysis: Impact of Emergency Department Nursing Interventions on Patient Safety and Clinical Outcomes:

Keywords

Emergency nursing
patient safety
nursing interventions
clinical outcomes
meta-analysis
Subjects
[1] Smith, J. A., Johnson, M. B., Williams, R. C., et al. (2025). Evaluating the efficacy of nursing interventions in reducing infection rates among emergency department patients: A systematic review and meta-analysis. International Emergency Nursing, 78, 101456.     
[2] Onyejesi, C. D., Okonkwo, K. U., Eze, P. C., et al. (2025). Improving patient outcomes through quality improvement and safety culture interventions in pediatric emergency care: A systematic review of best practices. International Journal of Emergency Medicine, 18(1), 217.
[3] Fu, C. H., Ju, M. J., Li, Y., et al. (2026). Effectiveness of nurse-led interventions on emergence delirium in pediatric patients: A systematic review and meta-analysis. Journal of Clinical Nursing, 35(6), 2606-2621.       
[4] Arjmand, A. and Asheghvatan, A. (2025). Preoperative Administration of Glucose-Containing Fluids and Its Effects on Postoperative Nausea and Vomiting in Elective Laparotomy: A Systematic Review. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(7), 222-230.
[5] Varndell, W., Fry, M., & Elliott, D. (2018). Quality and impact of nurse-initiated analgesia in the emergency department: A systematic review. International Emergency Nursing, 40, 46-53.
[6] Millichamp, T., Johnston, A. N. B., & Kain, V. J. (2020). Interventions to support safe medication administration by emergency department nurses: An integrative review. International Emergency Nursing, 49, 100811.
[7] Van Spall, H. G. C., Rahman, T., Mytton, O., et al. (2021). Effects of nurse-led transitional care interventions for patients with heart failure on healthcare utilization: A meta-analysis of randomized controlled trials. PLOS ONE, 16(12), e0261300.           
[8] Sakashita, C., Endo, E., & Okada, S. (2025). Effectiveness of nurse-led transitional care interventions for adult patients discharged from acute care hospitals: A systematic review and meta-analysis. BMC Nursing, 24(1), 1-21.
[9] Okonkwo, C. D., Adebayo, K. U., & Okafor, P. C. (2026). Effectiveness of emergency surgeries performed by nurse-surgeons and other non-physician providers: A systematic review and proportional meta-analysis. BMC Nursing, 25(1), 78.            
[10]             Sosan, N. Y. N., Almonis, J. A. M., Almones, R. A., et al. (2025). The impact of nursing interventions in emergency care settings: A comprehensive review of clinical decision-making, patient safety, and outcome improvement. The Review of Diabetic Studies, 21(2), 45-62.
[11]             Zakerimoghadam, M. and Karami, F. (2025). Evaluation of the relationship between perceived social support and self-care in women with preeclampsia referring to the emergency room of a selected hospital in Ilam. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR), 1(10), 342-351.
[12]             Karami, F. (2025). Diagnostic accuracy of artificial intelligence in predicting admission status, intensive care and mortality in the Nursing department: A Systematic Review and Meta-Analysis. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR), 1(10), 352-364.
[13]             Burgess, L., Ray-Barruel, G., O'Brien, S., & Roach, K. (2021). The effectiveness of nurse-initiated interventions in the Emergency Department: A systematic review. Australasian Emergency Care, 24(4), 248-254.       
[14]             Bazavluk, T., Pant, U., Vyas, K., Hunter, K., & Papathanassoglou, E. (2022). A scoping review of the impact of emergency department nurse practitioners on healthcare outcomes in Canada patient safety solution. International Journal of Critical Care, 16(2), 12-31.   
[15]             Li, Y., Lyu, H., Chen, C., & Zhang, Y. (2026). Effectiveness of nursing interventions for the management of critically ill patients with severe respiratory conditions: A systematic review and meta-analysis. Nursing in Critical Care.            
[16]    Horestani, M. K. (2025). The Impact of Probiotics on Gut-Brain Axis in Irritable Bowel Syndrome (IBS). Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(7), 213-221.
[17]             Dermody, G., Whitehead, L., Wilson, G., & Glass, C. (2020). The effectiveness of pictorial discharge advice versus standard advice following discharge from the ED: A systematic review and meta-analysis. Australasian Emergency Care, 23(3), 175-182.     
[18]             Jiang, Y., Hu, J., Zhao, J., Wang, L., Gao, J., Yang, M., & Zhao, Y. (2026). Network meta-analysis of the effect of different nursing management models on the intra-hospital transport of critically ill patients in the emergency department. International Emergency Nursing.
[19]    Milanifard, M. and Hashemloo, A. (2025). Facial fillers: Relevant anatomy, injection techniques, and complications. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(7), 204-212.
[20]    Samimi, A. (2025). Assessment of Risks Arising from Neuropsychological Crises in Cardiac Patients Using FMEA. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(7), 196-203.
[21]             Carter, A. J. E., & Chochinov, A. H. (2007). A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department. CJEM, 9(4), 286-295. 
[22]    Bilehjani, E. , Fakhari, S. and Ziyaazar, A. (2025). Evaluation of the Effects of Vitamin C Supplementation on the Incidence of Postoperative Complications Following Cardiac Surgery. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(6), 188-195.
[23]             Varndell, W., Fry, M., & Elliott, D. (2021). Nurse-initiated analgesia for patients with acute pain in the emergency department: A systematic review. Emergency Medicine Australasia, 33(1), 13-22.
[24]             Fry, M., & Atti, J. (2021). The impact of emergency department nursing workforce models on patient outcomes: A systematic review. Journal of Clinical Nursing, 30(15-16), 2144-2155.
[25]             Considine, J., & Currey, J. (2015). The role of emergency department nurses in patient safety: A systematic review. International Emergency Nursing, 23(4), 267-274.     
[26]             Wolf, L. A., Perhats, C., Delao, A. M., & Clark, P. R. (2017). The impact of emergency department nursing interventions on patient outcomes: An integrative review. Journal of Emergency Nursing, 43(6), 531-538.
[27]             De Magalhães-Barbosa, M. C., Robaina, J. R., Prata-Barbosa, A., & Lopes, C. S. (2019). The effectiveness of early warning systems in the emergency department: A systematic review. PLoS ONE, 14(8), e0220733.              
[28]             Benoit, E. L., & Yang, H. (2020). Nursing interventions to improve medication safety in the emergency department: A systematic review. Journal of Patient Safety, 16(3S), S1-S8.
[29]             Sharif, L., Al-Tawfiq, J. A., & Alshammari, M. (2021). The role of emergency department nurses in infection prevention and control: A systematic review. American Journal of Infection Control, 49(6), 789-796.
Gerdtz, M. F., & Bucknall, T. K. (2019). The impact of emergency department triage nursing interventions on patient flow and outcomes: A systematic review. Academic Emergency Medicine, 26(4), 421-434.
Medicinal, Psychological, and Health Research Journal (MPHRJ)
Volume 2, Issue 3
Spring 2026
Pages 199-211

Home

Editorial Board

Guide for Authors

Submit Manuscript

Contact Us