Output

Table 1: Interventions With Promise

Intervention or strategy	Description
Align acute care bed capacity within hospitals	To account for over occupancy and bottlenecks on wards, particularly the surgical ward, simulation scenario testing was undertaken to support bed capacity management. The optimal solution was deemed to be inpatient bed occupancy of 70-85%.
Active bed management	Dedication of staffed positions to ensure timely identification and allocation of inpatient beds, including communication around discharge and bed availability.
Hospital-led transitional care	Time-limited health services that may include patient or caregiver education on self-management, discharge planning, structured follow-up, and coordination among health care professionals involved in transition planning between EDs, hospitals, and primary and community care.
Care coordination and transition strategies	Deliberate coordination of care between 2 or more health system partners, and may include case management, changing of roles, and support for self-management and decision-making.
Rapid transfer of patients admitted in the ED to inpatient wards	Strategies to enhance capacity and efficiency to rapidly transfer patients admitted in the ED to inpatient wards, for example multidisciplinary rounding, or boarding patients within wards as opposed to the ED.
Discharge planning and coordination of services	Dedicating a health professional responsible for improving transitional care to home or other health care facilities (e.g., discharge to home or nursing home, hospital admission, rehabilitation centre) by developing individualized discharge plans that include treatment summaries, medication and referral plans, transportation plans, community services, and primary care referrals.

ED = emergency department.

Table 2: Moderate- and High-Quality Conclusive Evidence^a

Intervention	Description	Characteristics across evidence^b	Intervention effectiveness by outcome^c
Discharge planning	Discharge planning and coordination of services by ED nurses	All ages Older adults People who access the ED frequently	ED revisits: favourable

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.

Table 3: New and Emerging Interventions

Intervention	Description	Implemented where?
Discharge lounges	Lounge for patients to wait for a final treatment, transfer, or other intervention before leaving the hospital	Al-Zahra Hospital (Iran) London Health Sciences Centre (London, Ontario)
Changing time of discharge	Literature review of access block solutions	Researchers from Australia and New Zealand
Enhanced hospital-wide patient flow	Multidisciplinary rounding team to address real-time barriers to patient flow	US
Inpatient hallway boarding	Commentary and literature review about misaligned health care economics and financial pressures	US
Accountable care team to support hospital discharge	Multidisciplinary quality improvement to address inefficiencies and assure throughput progress for timely, effective, and patient-centred discharge	US
Capacity physician role	Physician role to aid in patient access, progress of care, and discharge	US
Discrete event simulation for bed capacity management	Simulation scenario testing to optimize hospital bed numbers, reduce length of stay, reduce discharge delays, and evaluate alternative solutions to bed management	Researchers from Kuwait
Partially flexible routing algorithm	Algorithm to assist assigning admitted ED patients to inpatient wards	Researchers from Canada, Iran, the US
Reintegration and reactivation care models in long-term care and congregate living	Supportive transitional home for people who no longer need acute care and lack home or community supports “Reactivation care centres” provide activation therapies to support people as they transition to home or an alternate level of care	Pine Villa (Toronto, Ontario) Greater Toronto Area, Ontario
Complex care hub	Patients receive support in their homes from community paramedic, a nurse navigator, and a general internist	Alberta
Patient hotels	For people awaiting long-term care facility or other arrangements	Europe

ED = emergency department.
Note: leaf indicates implemented in Canada indicates implemented in Canada.

Table 4: Inconclusive, Unfavourable, or Low-Quality Evidence

Intervention	Characteristics across evidence^a	Intervention effectiveness by outcome^b
Nurse discharge coordinator	Older adults	Patient satisfaction: moderate quality, favourable, inconclusive
Older adult risk assessment tool and referral to services upon discharge	Older adults	ED visits or revisits: low quality, neutral, conclusive
Active bed management, flexible acute admission unit for admitted patients and interhospital transfers	Adults	ED length of stay; moderate quality, favourable or neutral evidence, inconclusive Ambulance bypass time; moderate quality, neutral, inconclusive
Enhanced care or discharge planning for hospitalized patients, including with personal emergency response system)	Older adults	ED revisits, low quality, neutral, inconclusive

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.

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Output

Table 1: Interventions With Promise

Intervention or strategy

Description

Table 2: Moderate- and High-Quality Conclusive Evidencea

Intervention

Description

Characteristics across evidenceb

Intervention effectiveness by outcomec

Table 3: New and Emerging Interventions

Intervention

Description

Implemented where?

Table 4: Inconclusive, Unfavourable, or Low-Quality Evidence

Intervention

Characteristics across evidencea

Intervention effectiveness by outcomeb

Table 2: Moderate- and High-Quality Conclusive Evidence^a

Characteristics across evidence^b

Intervention effectiveness by outcome^c

Characteristics across evidence^a

Intervention effectiveness by outcome^b