Understanding Strategies to Reduce the Impact of Non-urgent Visits to the Pediatric Emergency Department: A Scoping Review.

Abstract

Context: 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.

Objective: 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.

Data sources: We searched 4 databases (MEDLINE, EMBASE, EBM, and CINAHL) to identify research published from the database inception until March 31, 2024.

Study selection: 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.

Data extraction: 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.

Results: 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.

Conclusions: 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.