Crawford Jessica, Cooper Simon, Cant Robyn, DeSouza Ruth
School of Nursing and Midwifery, Monash University, PO Box 1071, Narre Warren, Vic 3805, Australia.
School of Nursing and Midwifery, Federation University, Gippsland Campus, Northways Road Churchill 3842, Australia.
Int Emerg Nurs. 2017 Sep;34:36-42. doi: 10.1016/j.ienj.2017.04.002. Epub 2017 May 12.
Internationally, non-urgent presentations are increasing the pressure on Emergency Department (ED) staff and resources. This systematic review aims to identify the impact of alternative emergency care pathways on ED presentations - specifically GP cooperatives and walk-in clinics.
Based on a structured PICO enquiry with either walk-in clinic or GP cooperative as the intervention, a search was made for peer-reviewed publications in English, between 2000 and 2014. Medline plus, OVID, PubMed, and Google Scholar were searched. The Critical Appraisal Skills Program (CASP) guidelines were used to assess study quality and data was extracted using an adapted JBI Qualitative Assessment and Review Instrument (QARI). Subsequent reporting followed the PRISMA guideline.
Eleven high quality quantitative studies met the inclusion criteria. Walk-in clinics do have the potential to reduce non-urgent emergency department presentations, however evidence of this effect is low. GP cooperatives offer an alternative care stream for patients presenting to the ED and do significantly reduce local ED attendances. Community members need to be made aware of these options in order to make informed treatment choices.
GP cooperatives in particular do have the potential to reduce ED workload. Further research is required to uncover recent trends and patient outcomes for walk-in clinics and GP cooperatives.
在国际上，非紧急就诊情况给急诊科工作人员和资源带来了越来越大的压力。本系统评价旨在确定替代急诊护理途径对急诊科就诊情况的影响——特别是全科医生合作社和随诊诊所。
基于以随诊诊所或全科医生合作社为干预措施的结构化PICO询问，检索了2000年至2014年间的英文同行评审出版物。检索了医学期刊数据库（Medline plus）、OVID、PubMed和谷歌学术。使用批判性评估技能计划（CASP）指南评估研究质量，并使用改编后的JBI定性评估与综述工具（QARI）提取数据。后续报告遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。
11项高质量的定量研究符合纳入标准。随诊诊所有潜力减少非紧急情况下的急诊科就诊，但这种效果的证据不足。全科医生合作社为前往急诊科就诊的患者提供了另一种护理途径，并且确实显著减少了当地急诊科的就诊人数。需要让社区成员了解这些选择，以便他们做出明智的治疗选择。
特别是全科医生合作社有潜力减轻急诊科的工作量。需要进一步研究以揭示随诊诊所和全科医生合作社的最新趋势及患者治疗结果。
