Abstract
The pediatric emergency department (PED) is increasingly being used for non-urgent reasons. This impacts PED input and throughput, and contributes to overcrowding. To identify solutions, it is essential to identify and describe the approaches that have been trialed. We completed a scoping review to identify and then describe the design and outcomes of all initiatives undertaken to reduce the impact of non-urgent visits on the PED. We searched 4 databases (MEDLINE, EMBASE, EBM, and CINAHL) to identify research published from the database inception until March 31, 2024. Studies met our inclusion criteria if they focused on the pediatric ED, defined non-urgent visits, described an intervention (hypothesizing it would reduce the impact of non-urgent visits on the PED), and reported on the interventions impact. The title and abstract of each study were independently screened for inclusion by 2 reviewers (E.Q., K.N.), and disagreements were resolved by deliberation until consensus was achieved. This process was then repeated for the full text of all articles. In total, we screened 11,600 articles and 20 were included. Nine interventions focused on PED input, 10 on PED throughput, and 1 on both PED input and throughput. Definitions of non-urgent visits and outcomes measures used to assess the effectiveness of an intervention differed between studies. Three types of strategies employed to reduce the impact of non-urgent visits on the PED were identified, these include (1) engaging nonpediatric emergency medicine clinicians by including them into the PED or connecting non-urgent patients to community locations for care, (2) reorganizing PED operations in anticipation of non-urgent visits, and (3) providing education to prevent future non-urgent visits. Consistent definitions of non-urgent visits and standardized outcome measures may allow for more precise comparisons between studies. We identify 3 commonly employed strategies that may help reduce the impact of non-urgent visits on the PED.
Published Version
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