Table 1: Interventions With Promise
Intervention or strategy |
Description |
|---|---|
| Rapid assessment zones or fast-track zones in moderate- and large-sized EDs | Rapid assessment and fast-track zones complement or replace typical triage processes to identify patients who will likely remain ambulatory versus requiring further ED, hospital, or other health care services. These typically include dedicated spaces in the ED that can support patients in a chair vs. ED bed and require relatively limited observation. |
| Virtual ED care | ED care delivered using secure video conferencing software or video-based telemedicine, ideally embedded into the hospital’s electronic medical record. |
| Consistent accountability for patient flow | Identifying and implementing dedicated human resources accountable for patient flow during all operational hours. This may occur via CEO-led direction, by employing a director of patient flow, or other interventions. |
| Rapid viral testing | Provision of same-day identification of influenza, parainfluenza virus, COVID-19, RSV, and adenovirus to inform patient management and triage decisions. |
| Nurse-initiated X-rays in the ED | X-rays initiated by nurses vs. physicians within the ED and using standard-of-care X-ray ordering decision-making protocols, such as the Ottawa Ankle Rules, when available. |
| Short-stay crisis units for mental health | Therapeutic spaces for stabilization, assessment, and appropriate referral, with the aim of reducing ED mental health presentations and wait times and/or psychiatric admissions. |
| Advanced triage protocols | Standardized approaches applicable to specific groups of patients for which a triage professional initiates diagnostic or therapeutic actions before the patients are seen by a physician. |
ED = emergency department; RSV = respiratory syncytial virus.
Table 2: Moderate- and High-Quality Conclusive Evidencea
Intervention |
Description |
Characteristics across evidenceb |
Intervention effectiveness by outcomec |
|---|---|---|---|
| Short-stay crisis units for mental health | Hospital-based therapeutic space that provides overnight stays for a short time, stability, assessment, and appropriate referral |
|
|
| Advanced triage protocols | Standardized approaches for specific patients that begin diagnostic testing or treatment before being seen by a physician |
|
|
| Rapid influenza testing | Rapid viral detection test for children with breathing symptoms and fever |
|
|
| Nurse-initiated X-rays | Expanding scope of practice of ED nurses to request and interpret diagnostic tests |
|
|
ED = emergency department.
a Interventions with certain evidence or evidence with some uncertainty (moderate or high certainty) that is moderate or high quality based on AMSTAR 2 ratings.
b Population and setting characteristics of the individual studies that contributed to the evidence.
c The outcome measured in the evidence with its effectiveness across the evidence. Favourable: certain evidence or evidence with some uncertainty of better effectiveness of the intervention versus a comparator. Neutral: certain evidence or evidence with some uncertainty (moderate or high certainty) that neither the intervention nor the comparator was favoured.
Table 3: New and Emerging Interventions
ED = emergency department.
Note: 
indicates implemented in Canada.
Table 4: Inconclusive, Unfavourable, or Low-Quality Evidence
Intervention |
Characteristics across evidencea |
Intervention effectiveness by outcomeb |
|---|---|---|
| Needs assessment by nurses or care coordination teams in ED |
|
|
| Interventions to improve operational ED processes for children (e.g., virtual observation units, pediatric EDs, general practitioner cooperatives in the ED, pediatrician at triage, pediatric consultation liaison team) |
|
|
| Primary health care practitioner at triage (e.g., general practitioner, nurse practitioner, nurse, primary care provider, primary care nurse practitioner, primary care triage nurse with team triage) |
|
|
| Lean health care interventions supported by digital technologies (e.g., electronic medical records, charting, and patient tracking systems; automation systems) |
|
|
| ED consultation interventions (e.g., improving access to consultants in ED, expediting ED consultations) |
|
|
| ED-based models of care (e.g., clinical case management, care coordination, patient navigation) |
|
|
| Nurse-initiated interventions in ED (e.g., analgesia, treatment protocols) |
|
|
| Medical scribes to support clinicians |
|
|
| Dedicated care for urological patients in EDs |
|
|
| Nurse-led care coordination program |
|
|
| Triage liaison providers in ED |
|
|
| Nurse-implemented Manchester Triage System in ED |
|
|
| Triage interventions to reduce ED crowding (e.g., physicians in triage, nurse- or physician assistant–led triage, team triage) |
|
|
| Medical scribes |
|
|
| New provider roles (e.g., new nurse practitioners in ED, physiotherapist as primary provider in ED, primary care physician in ED, weekly attending physiatrist in ED, dedicated urologist, nurse-initiated X-rays) |
fractures, minor wounds
|
|
| Improvements in diagnostic testing (e.g., laboratory testing, point-of-care testing, imaging) |
|
|
| Patient streaming (e.g., split flow or fast track) |
|
|
| Lean interventions |
|
|
| Patient tracking or computerized text messaging |
|
|
| Electronic documentation system with alerts |
|
|
| Electronic health records in EDs |
|
|
| Pharmacist in ED (medication reviews and patient interviews) |
|
|
| ED-based care coordination |
|
|
| Nurse interventions to maintain patient flow in EDs (e.g., nurse navigators, flow coordinators, case managers, mental health liaison nurse, nurse practitioner in triage, nurse coordinator for bed management) |
|
|
| Lean interventions |
|
|
| Pelvic point-of-care ultrasound |
|
|
| Early assessment by health and social care teams |
|
|
| Nurse-initiated X-rays |
|
|
| Liaison psychiatry services (e.g., mental health practitioners in ED, triage tools for mental health, access centres with social workers and mental health therapists, psychiatric daily rounds, psychiatric fast-track service, external specialist units with crisis assessment or psychiatric emergency services) |
|
|
| Deferral of care to real-time electronic notifications |
|
|
| Redirection to nonemergency setting at later date or onsite primary care clinic |
|
|
| Physical therapists in EDs |
|
|
| Nurse-led interventions |
|
|
| Primary care professionals in EDs (e.g., nurse practitioner, sessions general practitioners) |
|
|
| Earlier physician assessment (e.g., rapid assessment policy, improved triage, improved specialty consultation process) |
|
|
| Physician at triage |
|
|
| Fast-track or flexible care areas |
|
|
| Changes in diagnostic testing (e.g., point-of-care testing, initiating lab tests in ED, dedicated laboratory) |
|
|
| Nurse navigator in ED |
|
|
| Nurse-initiated protocols |
|
|
| Bedside registration |
|
|
| Earlier inpatient consultation |
|
|
| Increased number of ED beds |
|
|
| Nurses initiating medications |
|
|
| Patient-centred education on asthma |
|
|
| Aged care pharmacist (medication reconciliation, review, and referral) |
|
|
| Specialist nurse assessments |
|
ED revisits: low quality, neutral, inconclusive |
| ED medical assessment units |
|
ED revisits: low quality, favourable, inconclusive |
| Specialist geriatric ED |
|
|
| Screening strategies (laboratory tests or medical clearance) |
|
|
| Specialized models of care (behavioural health unit or child guidance model) |
|
|
| Acute medical assessment units |
|
|
| Nurse or nurse practitioner-initiated Ottawa Ankle Rules |
|
|
| Triage team in EDs |
|
|
| Senior doctor at triage |
|
|
| Nurse-led initiation of Ottawa Ankle Rules in ED |
|
|
| Short-stay units in ED |
|
|
| Nurse practitioner in ED |
|
|
| Rapid influenza testing |
|
|
| Electronic patient tracking in pediatric EDs |
|
|
| Nurse reviews diagnosis and prescriptions, arranges follow-up appointments and transportation, and identifies community resources |
|
|
ED = emergency department.
a Population and setting characteristics of the individual studies that contributed to the evidence.
b The outcome measured in the evidence with its quality based on A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2) ratings and the effectiveness across the evidence. Inconclusive: very uncertain evidence (has low or very low certainty). Unfavourable: unfavourable effectiveness of the intervention on outcomes versus a comparator. Low quality: systematic review has a critical flaw based on AMSTAR 2 ratings and may not provide an accurate and comprehensive summary of the available studies that address the question of interest. Moderate quality: systematic review has more than 1 weakness, but no critical flaws. High quality: systematic review provides an accurate and comprehensive summary of the results of the available studies that address the question of interest. Favourable: certain evidence or evidence with some uncertainty of better effectiveness of the intervention versus a comparator. Neutral: certain evidence or evidence with some uncertainty (moderate or high certainty) that neither the intervention nor the comparator was favoured. Mixed: heterogeneous results for effectiveness of an intervention versus a comparator, and the heterogeneity is too serious to draw a conclusion. Unfavourable: unfavourable effectiveness of the intervention on outcomes versus a comparator. Inconclusive: very uncertain evidence (has low or very low certainty). No evidence: there is no evidence from primary studies.