Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

Abstract

ObjectivesTo conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding.DesignA scoping review.Data sourcesA comprehensive database search of Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) databases was conducted (inception until January 2020) using peer-reviewed search strategies, complemented by a search of grey literature sources.Eligibility criteriaInterventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding.MethodsWe engaged and collaborated, with 13 patient partners during the design and conduct stages of this review. We conducted this review using the JBI guidelines. Two reviewers independently selected studies and extracted data. We conducted descriptive analysis of the included studies (frequencies and percentages).ResultsFrom 23 947 records identified, we included 268 studies published between 1981 and 2020. The majority (58%) of studies were conducted in North America and were predominantly cohort studies (42%). The reported interventions were either ‘within ED’ (48%) interventions (eg, PHCP-led ED triage or fast track) or ‘outside ED’ interventions (52%) (eg, after-hours GP clinic and GP cooperatives). PHCPs involved in the interventions were: GP (32%), NP (26%), nurses with expanded role (16%) and combinations of the PHCPs (42%). The ‘within ED’ and ‘outside ED’ interventions reported outcomes on patient flow and ED utilisation, respectively.ConclusionsWe identified many interventions involving PHCPs that predominantly reported a positive impact on ED utilisation/patient flow metrics. Future research needs to focus on conducting well-designed randomized controlled trials (RCTs) and systematic reviews to evaluate the effectiveness of specific interventions involving PHCPs to critically appraise and summarise evidence on this topic.

Time-series cohort study to forecast emergency department visits in the city of Milan and predict high demand: a 2-day warning system

“…We did not investigate throughput factors, describing organisational issues in the ED, such as inadequate staffing, nor output factors. The latter includes one of the major reasons for ED overcrowding, which is the shortage of acute care bed capacity 6–10. Among the most investigated input factors are non-urgent visits, meaning ‘patients who could have been assessed and treated in other facilities that treat less urgent cases’ 11.…”

Overcrowding in Emergency Department: Causes, Consequences, and Solutions—A Narrative Review

“…Another intervention on triage that has been promising is to give nurses more authority, for example, by giving them the ability to request diagnostic tests, such as X-rays, even before the physician has examined the patient [ 5 , 39 , 43 ]. However, it is highly recommended that nurses acquire adequate training before assuming this additional role [ 26 ].…”

Feasibility and evaluation of an emergency department‐based general practitioner streaming and treatment service

“…However, the optimal delivery format of such programmes and the level of care they should offer remain unclear. Jeyaraman et al 30 systematically reviewed programs that consisted of primary health care professionals operating in a triage capacity at EDs. Their focus was on outcomes that could indicate reduced demand within EDs such as overcrowding and shorter length of stay.…”

“…The Short Warwick-Edinburgh Mental Well-being Scale was completed at least once by eight GPST staff with a mean score of 28.8 (range [28][29][30][31][32][33][34][35] for the first completion indicating good mental wellbeing for GPST staff. (p = 0.430) for the concurrent GPST group compared to the pre-GPST group.…”