Impact of diversion on subsequent ED visits
| Study | Intervention | Comparison | Outcome | Result |
| Pre-hospital diversion | ||||
| Mason (2007)11 | Paramedic practitioner+ambulance crew to assess and treat at the scene | Transport to ED | ED attendance (0–28 days)* | RR†0.72 (95% CI 0.69 to 0.75) |
| Mason (2008)15 | Subsequent ED attendance within 7 days | RR†1.25 (95% CI 1.01 to 1.53) | ||
| Callers with ED attendance who returned to the ED for a similar clinical condition | 75.2% vs 72.1% (P=0.64) | |||
| Ross (2013)25 | Paramedic evaluation and transport to a detoxification facility | Transport to ED | ED attendance by diverted patients for an adverse event within 12 hours of detoxification facility arrival | 2.9% vs NR |
| Snooks (2004)16 | Ambulance crew transport to a minor injury unit | Transport to ED | Patients subsequently transferred to ED from the minor injury unit | 9%§ vs NR |
| Snooks (2014)13 | Ambulance crew referral to community-based falls service | Transport to ED | Subsequent ED visits within 1 month of the index call | RR†1.10 (95% CI 0.74 to 1.62) |
| Snooks (2017)12 | Ambulance crew referral to community-based falls service | Transport to ED | Subsequent ED visits within 1 month of the index call. Subsequent ED visits within 6 months of the index call | RR†0.93 (95% CI 0.83 to 1.05) aOR‡1.07 (95% CI 0.92 to 1.24) RR†1.00 (95% CI 0.94 to 1.07) aOR‡1.00 (95% CI 0.89 to 1.12) |
| ED-based diversion | ||||
| Doran (2013)20 | Deferred to on-site primary care clinic | Usual ED care | Subsequent treat and release ED visits within 2 weeks of the index visit | RR†0.55 (95% CI 0.29 to 1.06) |
| Ellbrant (2015)23 | PED nurse | PED physician | Diverted patients who returned to the ED within 72 hours with similar symptoms | 7.6% vs NR |
*Includes ED visits at time of diversion (initial ED visits) and within 28 days follow-up (subsequent visits).
†Unadjusted RR.
‡As well as indicators for group, site and their interaction, covariates adjusted for included age and its square, distance to ED, recruitment point, seasonality, sex and whether or not the index call was made out of GP hours.
§This value includes patients from both the intervention and comparison groups who were transported to the minor injury unit.
a, adjusted; ED, emergency department; NA, not applicable; NR, not reported; PED, paediatric emergency department; RR, relative risk.