The Safety and Interventions for Redirecting Non-Urgent Patients From Emergency Departments to Primary Care Services: A Scoping Review.

BACKGROUND

Emergency departments (EDs) experience overcrowding, resulting in delayed care for life-threatening conditions, increased healthcare costs, and prolonged waiting times. Non-urgent patients contribute to ED overcrowding, and redirecting these patients to primary care (PC) is a strategy to reduce pressure on emergency services. However, the safety and procedural components of redirection have not been comprehensively described due to limited evidence. This scoping review aimed to identify the safety outcomes and intervention components associated with redirecting non-urgent patients from EDs to PC.

METHODS

Five electronic databases were searched. Eligible studies included non-urgent patients presenting to EDs who were redirected to PC, reported safety outcomes, and described redirection procedures. Two reviewers independently conducted title and abstract screening and full-text screening using Rayyan.ai and assessed study quality. Safety outcomes included return visits, hospitalisation, death, and adverse events, which were compared across studies. Redirection procedures were identified using the Innovation domain of the Consolidated Framework for Implementation Research (CFIR).

MAIN

RESULTS

Nine studies met the inclusion criteria, including eight observational studies and one randomised controlled trial. The highest reported safety outcomes were a 9.7% return rate, a 1.7% hospitalisation rate, and a 0.07% mortality rate. Most reported components across all studies included documentation of chief complaints, patient registration, measurement of vital signs, and triage. Studies reporting zero hospitalisations and deaths included multiple constructs within the CFIR Innovation domain.

CONCLUSION

Redirecting non-urgent patients from EDs to PC appears safe and acceptable when clear criteria are implemented; however, evidence remains limited.