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Evidence on ED Diversion Strategies Inconclusive

FRIDAY, Dec. 21, 2018 -- There is insufficient evidence to recommend the implementation of diversion protocols as effective strategies to address emergency department overcrowding, according to a review published online Nov. 27 in the Emergency Medicine Journal.

Scott William Kirkland, from the University of Alberta in Edmonton, Canada, and colleagues conducted a systematic literature review of randomized controlled trials and cohort studies that assessed the effectiveness of prehospital (11 studies) or emergency department-based (four studies) diversion interventions.

The researchers found that the quality of the studies ranged from moderate to low. In three prehospital studies, patients deemed suitable for diversion ranged from 19.2 to 90.4 percent, while the range was 19 to 36 percent in four emergency department-based studies. The proportion of eligible patients diverted via emergency department-based diversion tended to be higher than that based on prehospital diversion (median, 85 versus 40 percent). Compared with standard care, prehospital diversion did not decrease the proportion of patients transferred to the emergency department (relative risk, 0.92). Patients diverted via prehospital diversion had no significant decrease in subsequent emergency department utilization compared with nondiverted patients (relative risk, 1.09). Further, there was no significant difference in total health care costs between diverted and nondiverted patients in the three prehospital studies.

"The overall quality of the research limited the ability of this review to draw definitive conclusions and more research is required prior to widespread implementation," the authors write.

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Posted: December 2018

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