George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
BMJ Open. 2021 May 10;11(5):e048613. doi: 10.1136/bmjopen-2021-048613.
To conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding.
A scoping review.
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.
Interventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding.
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).
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.
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.
进行范围综述，以确定和总结涉及初级保健专业人员管理急诊科（ED）过度拥挤的干预措施的现有文献。
范围综述。
对 Medline（Ovid）、EMBASE（Ovid）、Cochrane 图书馆（Wiley）和 CINAHL（EBSCO）数据库进行了全面的数据库检索（从开始到 2020 年 1 月），使用同行评审的搜索策略，并辅以灰色文献来源的搜索。
涉及初级保健专业人员（PHCP：全科医生（GP）、执业护士（NP）或扩大角色的护士）管理 ED 过度拥挤的干预措施和策略。
我们在设计和进行本综述的阶段与 13 名患者合作伙伴合作。我们使用 JBI 指南进行了这项综述。两名审查员独立选择研究并提取数据。我们对纳入的研究进行了描述性分析（频率和百分比）。
从 23947 条记录中，我们纳入了 1981 年至 2020 年期间发表的 268 项研究。大多数（58%）研究在北美进行，主要是队列研究（42%）。报告的干预措施要么是“在 ED 内”（48%）干预措施（例如，PHCP 领导的 ED 分诊或快速通道），要么是“在 ED 外”干预措施（52%）（例如，下班后的 GP 诊所和 GP 合作社）。参与干预措施的 PHCP 包括：GP（32%）、NP（26%）、扩大角色的护士（16%）和 PHCP 的组合（42%）。“在 ED 内”和“在 ED 外”干预措施分别报告了患者流程和 ED 利用的结果。
我们确定了许多涉及 PHCP 的干预措施，主要报告对 ED 利用/患者流程指标有积极影响。未来的研究需要专注于进行精心设计的随机对照试验（RCT）和系统评价，以评估涉及 PHCP 的特定干预措施的有效性，以批判性地评估和总结关于该主题的证据。
