T
he NIHR commissioned rapid evidence review to assess the nature and quality of the existing evidence on delivery of emergency and urgent care services and to identify gaps for future research was published last week: Phung V-H (2015) Chapter 6 – Delivery of emergency department services in Turner J, Coster J, Chambers D, Cantrell A, Phung V-H, Knowles E, Bradbury D, Goyder (eds.). What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. Health Serv Deliv Res 2015;3(43). The team, from the School of Health And Related Research (ScHARR) at the University of Sheffield with Viet-Hai Phung, research assistant and doctoral researcher at CaHRU, undertook five separate literature reviews linked to themes in the NHS England review in 2013, which latter drove the need for this rapid evidence review. The review, which took six months to complete, incorporated findings from 45 systematic reviews and 102 primary research studies across all five reviews
Viet-Hai Phung wrote the review in Chapter 6 on the Delivery of Emergency Department (ED) services. This review included literature from 2009 to 2015. Nine papers were included in the review: two systematic reviews, which included 28 individual papers, and seven additional papers. Of the 35 included studies, there were only five randomised control trials and many uncontrolled before-and-after studies, which cannot control for other system effects.
There were three themes to this part of the review: Managing ED flow; Workforce; and managing the frail and the elderly in EDs. In the first review, interventions that aimed to increase access to primary care and ED cost-sharing were found to be effective in reducing ED use. For the Workforce review, the evidence suggested that supplementing existing ED staff with NPs can help to manage demand more effectively, especially in high-volume EDs. For the final review, there was mixed evidence about the effectiveness of Comprehensive Geriatric Assessment (CGA): CGA did not have a significant impact on outcomes nor mortality, while other studies suggested that use of CGA to inform interventions could reduce functional decline.
Viet-Hai Phung