Interventions to re-direct low-acuity patients from emergency department care: effects are uncertain

Added April 22, 2020

Citation: Kirkland S, Soleimani A, Rowe B, et al. A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze? Emergency Medicine Journal 2019; 36(2): 97-106

Free to view: No

What is this? The COVID-19 pandemic is placing a strain on healthcare systems. Existing research into ways to redirect patients away from emergency departments (ED) might inform policies and actions to ease this.

In this systematic review, the authors searched for comparative effectiveness studies that evaluated the redirection of patients before they arrive at the hospital or ED. They restricted the search to articles published in English between 1990 and 2016, and did their search in 2017. They included 10 clinical trials and 5 observational cohort studies. Overall, 11 studies evaluated pre-hospital diversion (7 clinical trials and 4 cohort studies) and 4 studies evaluated ED-based diversion (1 randomized trial and 3 cohort studies).

What was found: Pre-hospital diversion of patients did not significantly decrease the proportion of patients transferred to the ED, compared to standard care.

In the three pre-hospital studies that reported a cost analysis, none found a significant difference in total healthcare costs between diverted and non-diverted patients.

What’s uncertain: It is uncertain whether pre-hospital or ED-based diversion should, or should not, be used.


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