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N = 25 primary studies 4 RCT; 2 CCT; 3 Cohorts; 16 Before and After studies.
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Results
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All studies measured LOS.
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3 RCT - Statistically significant reduction in LOS.
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16 observational studies - Demonstrated statistically significant LOS reduction.
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The results indicate that a TLP reduces LOS and, to a lesser degree, the number of patients left without being seen in an overcrowded ED. In addition, there was high nurse satisfaction due to increased physician support and high physician satisfaction due to improved quality of work life.
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N = 28 primary studies
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2 RCT; 7 CCT, 2 Cohorts; 1 ITS; 16 Before and After studies.
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Results
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19 studies measured LOS.
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2 RCT: statistically significant reduction of 37 minutes.
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12 not-RCT: statistically significant reductions in the mean LOS between 82 and 11 minutes.
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3 not-RCT: unimportant reduction, no change or non-relevant increase in LOS.
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Use of triage nurse ordering (TNO)
Triage Nurses are authorized to request, from triage, imaging tests, lab tests or ECGs.
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N = 14 primary studies
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3 RCT; 1 CCT; 2 Cluster-cluster studies;
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8 Observational studies.
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Results
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14 studies measured LOS.
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2 RCT - Significant reduction of 37.2 minutes.
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8 not-RCT - Reduction of 51 minutes.
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When no fracture was suspected: non-significant LOS reduction of 0.93 minutes.
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Comparison of different triage systems:
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- Basic triage system versus no formal triage;
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- Basic triage with variations on team experience or with different triage criteria;
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- Triage with options management by physician vs. basic triage.
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N = 25 primary studies
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3 RCT; 5 NRCT; 16 Before and After; 1 ITS.
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Results
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7 studies measured LOS.
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Triage vs. No formal triage:
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1 RCT – No significant difference in LOS.
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Basic triage with different triage criteria:
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1 B&A – Mental health triage system, for patients
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with mental health conditions, caused LOS reduction of 17.5 minutes.
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Triage with options management by physician vs.
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basic triage:
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5 not-RCT – Reductions in LOS.
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AMU is associated with reduced LOS in the hospital, as well as the lower hospital mortality rate. Findings related to other items (patient satisfaction, readmission rate and other outcomes) are inconclusive.
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N = 9 primary studies
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9 Before and After studies.
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Results
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4 studies measured LOS.
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3 – Statistically significant mean reductions in average LOS in the hospital between 1 and 1.5 days.
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1 – Statistically non-significant reduction in the average LOS at the hospital in 0.5 days.
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N = 31 primary studies
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27 Before and After; 4 qualitative studies.
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Results
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15 studies measured LOS.
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3 – Measured LOS at the ED and 12 LOS in the hospital.
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3 – Mean hospital LOS reductions, ranging from 0.9 to 1.5 days.
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5 – Median hospital LOS reductions, ranging from 0.2 to 2 days, while one study found no difference in median hospital LOS.
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1 – Statistically significant reduction of hospital LOS, excluding the time in the ED, from 5.1 to 4.1 days.
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1 – Patients who were treated only in the AMU spent less time there on average.
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1 – Lower LOS in ED for patients of the Medical Evaluation Unit.
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N = 4 primary studies
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1 RCT; 1 CCT; 2 Before and After.
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Results
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2 studies measured LOS
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1 RCT – Statistically non-significant LOS reduction.
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1 B&A – Statistically significant LOS reduction.
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2 – Analyzed patient subgroups with severity scores of 2 to 5. Both observed LOS reduction for patients with a score of 5.
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N = 5 primary studies 5 RCT studies.
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Results
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4 studies measured LOS.
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2 – Statistically significant reduction in median LOS.
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1 – Statistically non-significant reduction in median LOS.
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1 – Statistically significant reduction in mean LOS.
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There is very weak evidence to suggest that GPs may use less resources to treat non-urgent patients in ED. Thus, while the intervention may provide cost-savings, it is unclear if less resource utilization translates into improved outcomes.
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N = 3 primary studies 3 NRCT studies.
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Results
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Zero studies measured LOS.
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Other outcomes:
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Reduction of laboratory and image diagnostic tests requested.
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Reduction in the number of hospitalizations.
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Rates of return to the ED or basic care in 30 days did not change.
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Cost reduction.
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Satisfaction of patients with care did not change.
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N = 14 primary studies 2 RCT; 2 NRCT; 10 observational studies.
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Results
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9 studies measured LOS.
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5 – Statistically relevant difference in LOS, ranging from 6 to 76 min.
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4 – No statistically significant difference in the LOS.
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N = 37 primary studies 3 RCT; 18 Case-control studies; 8 Cohorts; 8 Surveys.
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Results
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Zero studies measured LOS.
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Other outcomes:
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Statistically significant difference in favor of NPs in relation to cost – effectiveness.
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Positive difference in relation to LOS in the ED, but without statistical treatment.
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N = 5 primary studies 1 RCT; 3 Before and After; 1 ITS.
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Results
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1 study measured LOS.
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1 B&A – LOS at the ED had an average reduction of 5 hours.
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Subgroup analysis: For clinical patients, there was mean ED LOS reduction of 9 hours, for surgical patients, of 1.6 hours; for mental health patients, of 9.2 hours.
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LOS at the hospital had mean reduction of 1 day for clinical patients; 0.8 for surgical patients; 0.8 day for mental health patients.
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N = 9 primary studies All studies are Before and After.
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Results
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7 studies measured LOS.
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6 - Reduction of LOS.
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1 - Both reduction and increase of LOS, depending on where the study was conducted.
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