Table 3

Impact of diversion on non-ED healthcare utilisation

Pre-hospital diversion
 Dale (2003)18 Telephone-based assessment and advice from nurse or paramedicUsual ambulance responseDiverted callers assisted at the scene13.2% vs NR
 Diverted callers seen by GP within 7 days8.8% vs NR
 Diverted callers who engaged in self-care within 7 days4.4% vs NR
 Krumperman (2015)24 Telephone-based advice and/or referral to a PCP/urgent care centreAmbulance treated patient at scene and/or referred to a PCP or urgent care centrePercentage of patients who followed instructions95% vs 82%
 Mason (2007)11 Paramedic practitioner+ambulance crew to assess and treat at the sceneTransport to EDSubsequent unplanned contact with secondary care† within 28 daysRR* 1.21 (95% CI 1.06 to 1.38)
 Snooks (2004)16 Ambulance crew transport to a minor injury unitTransport to EDTransport to minor injury unitRR* 1.15 (95% CI 0.75 to 1.76)
 Snooks (2004)22 Treat at homeTransport to EDLeft at the sceneRR* 1.02 (95% CI 0.84 to 1.24)
 Snooks (2017)12 Ambulance crew referral to community-based falls serviceTransport to EDPatients with further emergency service call at 1 month post index callRR* 0.85 (95% CI 0.76 to 0.95)
aOR† 0.82 (95% CI 0.71 to 1.01)
 Patients with further emergency service call at 6 months post index callRR* 0.97 (95% CI 0.91 to 1.03)
aOR† 0.90 (95% CI 0.80 to 1.01)
ED-based diversion
 Doran (2013)20 Deferred to on-site primary care clinicUsual ED carePrimary care follow-upaRD‡ 11.3 (95% CI 6.0 to 16.5)
 Washington (2002)17 Deferred care at a non-emergency setting at a later dateUsual ED careSubsequently sought care from physician within 7 days± RR* 1.09 (95% CI 0.23 to 5.26)
 Diverted patients adherence to deferred care appointment95.9% vs NA
 Washington (2000)21 Diverted patients adherence to deferred care appointment90.3% vs NA
  • *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.

  • ‡Treatment effect adjusted for age, sex, race, education, insurance, previous PCC and ED/UC visits and self-reported health.

  • § Adjusted for ambulance site, age, sex and distance to nearest ED, date of recruitment and whether call was out of hours.

  • a, adjusted; ED, emergency department; NA, not applicable; NR, not reported; PED, paediatric emergency department; RD, risk difference; RR, relative risk.