Hospitalisation following diversion and standard emergency care
| Study | Intervention | Comparison | Outcome | Result |
| Pre-hospital diversion | ||||
| Dale (2003)18 | Telephone-based assessment and advice from nurse or paramedic | Usual ambulance response | Hospitalisation within 7 days | 12.1% vs NR |
| Mason (2007)11 | Paramedic practitioner+ambulance crew to assess and treat at the scene | Transport to ED | Hospitalisation within 28 days | RR* 0.87 (95% CI 0.81 to 0.94) |
| Ross (2013)25 | Paramedic evaluation and transport to a detoxification facility | Transport to ED | Hospitalisation within 2 years | RR* 0.16 (95% CI 0.02 to 1.06) |
| Snooks (2004)22 | Treat at home | Transport to ED | Hospitalisation within 14 days among patients treated at home | RR* 0.87 (95% CI 0.32 to 2.41) |
| Snooks (2014)13 | Ambulance crew referral to community-based falls service | Transport to ED | Patients with initial hospital stay at index call | RR* 0.62 (95% CI 0.52 to 0.73) |
| Patients with subsequent hospital stay by 1 month post index call | RR* 0.99 (95% CI 0.69 to 1.42) | |||
| Snooks (2017)12 | Ambulance crew referral to community-based falls service | Transport to ED | Proportion of patients with further emergency admission at 1 month post- index call | RR* 1.03 (95% CI 0.92 to 1.15) aOR† 1.04 (95% CI 0.90 to 1.20) |
| Proportion of patients with further emergency admission at 6 months post- index call | RR* 1.01 (95% CI 0.95 to 1.07) aOR† 1.00 (95% CI 0.89 to 1.13) | |||
| ED-based diversion | ||||
| Doran (2013)20 | Deferred to on-site primary care clinic | Usual ED care | Admitted at index visit | RR* 0.19 (95% CI 0.05 to 0.67) |
| Ellbrant (2015)23 | PED nurse | PED physician | Diverted patients hospitalised following ED return with 72 hours | 0.87% vs NR |
| Washington (2002)17 | Deferred care at a non-emergency setting at a later date | Usual ED care | Hospitalisation within 7 days | 0% vs 0% |
| Washington (2000)21 | Hospitalisation within 7 days | RR* 0.15 (95% CI 0.05 to 0.48) |
*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.
a, adjusted; ED, emergency department; NR, not reported; PED, paediatric emergency department; RR, relative risk.