Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review
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,
Scott W Kirkland,
Malcolm B Doupe,
Alecs Chochinov,
Gayle Halas,
Nameer Al-Yousif,
Rachel N Alder,
Yahya Al-Yousif,
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
Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Leslie Copstein
George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Ryan Zarychanski
1 Hematology and Medical Oncology, University of Manitoba/CancerCare Manitoba, Winnipeg, Manitoba, Canada
Andrea C Tricco
Knowledge Translation Program, Unity Health Toronto, St Michael’s Hospital Li Ka Shing Knowledge Institute, 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
Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Laval, Quebec, Canada
Rasheda Rabbani
George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
Scott W Kirkland
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, 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
Yahya Al-Yousif
George and Fay Yee Center for Healthcare Innovation, 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 conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding.Design A scoping review.Data sources A 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 criteria Interventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding.Methods We 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).Results From 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.Conclusions We 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.
