Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis
Brian H Rowe,
Maya M Jeyaraman,
Ahmed M Abou-Setta,
Leslie Copstein,
Ryan Zarychanski,
Andrea C Tricco,
Carolyn Shimmin,
Nicole Askin,
Simon Berthelot,
Rasheda Rabbani,
Malcolm B Doupe,
Alecs Chochinov,
Gayle Halas,
Nameer Al-Yousif,
Rachel N Alder,
Roger Suss,
Jean Mireault,
Patrick Tardif,
Tamara Buchel,
Thomas Beaudry,
Melissa Hartwell,
Jeanette Edwards,
William Sevcik
Affiliations
Brian H Rowe
Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
Maya M Jeyaraman
George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
Ahmed M Abou-Setta
George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Leslie Copstein
George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
Ryan Zarychanski
1 Hematology and Medical Oncology, University of Manitoba/CancerCare Manitoba, Winnipeg, Manitoba, Canada
Andrea C Tricco
Li Ka Shing Knowledge Institute, St. Michael`s Hospital, Toronto, Ontario, Canada
Carolyn Shimmin
George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
Nicole Askin
Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
Simon Berthelot
Centre de recherche du CHU de Québec-Université Laval, Axe Santé des populations et Pratiques optimales en santé, Laval, Quebec, Canada
Rasheda Rabbani
George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
Malcolm B Doupe
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Alecs Chochinov
Department of Emergency Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Gayle Halas
Manitoba Primary and Integrated Health care Innovation Network, Winnipeg, Manitoba, Canada
Nameer Al-Yousif
George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
Rachel N Alder
Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Roger Suss
Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Jean Mireault
HEC Pôle santé, Université de Montréal, Montreal, Quebec, Canada
Patrick Tardif
Department of Emergency Medicine, Cité de la santé de Laval, Laval, Quebec, Canada
Tamara Buchel
Manitoba College of Family Physicians, Winnipeg, Manitoba, Canada
Thomas Beaudry
Patient and Public Engagement Collaborative Partnership, George & Fay Yee Center for Healthcare Innovation, Winnipeg, Manitoba, Canada
Melissa Hartwell
Primary and Integrated Health care Innovation Network, Edmonton, Alberta, Canada
Jeanette Edwards
Community Health Quality and Learning, Shared Health Manitoba, Winnipeg, Manitoba, Canada
William Sevcik
Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
Objectives To identify, critically appraise and summarise evidence on the impact of employing primary healthcare professionals (PHCPs: family physicians/general practitioners (GPs), nurse practitioners (NP) and nurses with increased authority) in the emergency department (ED) triage, on patient flow outcomes.Methods We searched Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) (inception to January 2020). Our primary outcome was the time to provider initial assessment (PIA). Secondary outcomes included time to triage, proportion of patients leaving without being seen (LWBS), length of stay (ED LOS), proportion of patients leaving against medical advice (LAMA), number of repeat ED visits and patient satisfaction. Two independent reviewers selected studies, extracted data and assessed study quality using the National Institute for Health and Care Excellence quality assessment tool.Results From 23 973 records, 40 comparative studies including 10 randomised controlled trials (RCTs) and 13 pre–post studies were included. PHCP interventions were led by NP (n=14), GP (n=3) or nurses with increased authority (n=23) at triage. In all studies, PHCP-led intervention effectiveness was compared with the traditional nurse-led triage model. Median duration of the interventions was 6 months. Study quality was generally low (confounding bias); 7 RCTs were classified as moderate quality. Most studies reported that PHCP-led triage interventions decreased the PIA (13/14), ED LOS (29/30), proportion of patients LWBS (8/10), time to triage (3/3) and repeat ED visits (5/6), and increased the patient satisfaction (8/10). The proportion of patients LAMA did not differ between groups (3/3). Evidence from RCTs (n=8) as well as other study designs showed a significant decrease in ED LOS favouring the PHCP-led interventions.Conclusions Overall, PHCP-led triage interventions improved ED patient flow metrics. There was a significant decrease in ED LOS irrespective of the study design, favouring the PHCP-led interventions. Evidence from well-designed high-quality RCTs is required prior to widespread implementation.PROSPERO registration number CRD42020148053.
