Impact of diversion on non-ED healthcare utilisation
| Study | Intervention | Comparison | Outcome | Result |
| Pre-hospital diversion | ||||
| Dale (2003)18 | Telephone-based assessment and advice from nurse or paramedic | Usual ambulance response | Diverted callers assisted at the scene | 13.2% vs NR |
| Diverted callers seen by GP within 7 days | 8.8% vs NR | |||
| Diverted callers who engaged in self-care within 7 days | 4.4% vs NR | |||
| Krumperman (2015)24 | Telephone-based advice and/or referral to a PCP/urgent care centre | Ambulance treated patient at scene and/or referred to a PCP or urgent care centre | Percentage of patients who followed instructions | 95% vs 82% |
| Mason (2007)11 | Paramedic practitioner+ambulance crew to assess and treat at the scene | Transport to ED | Subsequent unplanned contact with secondary care† within 28 days | RR* 1.21 (95% CI 1.06 to 1.38) |
| Snooks (2004)16 | Ambulance crew transport to a minor injury unit | Transport to ED | Transport to minor injury unit | RR* 1.15 (95% CI 0.75 to 1.76) |
| Snooks (2004)22 | Treat at home | Transport to ED | Left at the scene | RR* 1.02 (95% CI 0.84 to 1.24) |
| Snooks (2017)12 | Ambulance crew referral to community-based falls service | Transport to ED | Patients with further emergency service call at 1 month post index call | RR* 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 call | RR* 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 clinic | Usual ED care | Primary care follow-up | aRD‡ 11.3 (95% CI 6.0 to 16.5) |
| Washington (2002)17 | Deferred care at a non-emergency setting at a later date | Usual ED care | Subsequently sought care from physician within 7 days± | RR* 1.09 (95% CI 0.23 to 5.26) |
| Diverted patients adherence to deferred care appointment | 95.9% vs NA | |||
| Washington (2000)21 | Diverted patients adherence to deferred care appointment | 90.3% 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.