SynthesisBMJ open2022
Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis.
Synthesis in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Ten-Year Update of Nurse Practitioner Service Impact on Patient and Health Service Outcomes in Emergency Care Settings-A Systematic Review.Journal of advanced nursing · 2026Pooled it
- Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system.BMC health services research · 2024Pooled it
- Impact of hospital restructuring on emergency department quality: a natural experiment.Internal and emergency medicine · 2026Article
- Leaving without being seen and against medical advice from the pediatric emergency department: a single-center retrospective cohort study in Türkiye.European journal of pediatrics · 2026Article
- Structural empowerment of triage nurses in the redirection of low-acuity patients in a Swiss emergency department: a mixed-methods convergent pilot study.BMC emergency medicine · 2026Article
- Left Without Being Seen: A Scoping Review of a Silent Crisis in Emergency Departments.Open access emergency medicine : OAEM · 2026Review
- Triage decisions and health outcomes among oncology patients: a comparative study of medical and surgical cancer cases in emergency departments.BMC emergency medicine · 2025Article
- Observational
- Scoping review of the effectiveness of 10 high-impact initiatives (HIIs) for recovering urgent and emergency care services.BMJ open quality · 2024Article
- Barriers and strategies for primary health care workforce development: synthesis of evidence.BMC primary care · 2024Review
- A global perspective of advanced practice nursing research: A review of systematic reviews.PloS one · 2024Review
- Modern Paediatric Emergency Department: Potential Improvements in Light of New Evidence.Children (Basel, Switzerland) · 2023Review
- Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews.PloS one · 2023Review
- Causal Association of Physician-in-Triage with Improved Pediatric Sepsis Care: A Single-Center, Emergency Department Experience.Pediatric quality & safetyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo identify, critically appraise and summarise evidence on the impact of employing primary healthcare professionals (PHCPs: family physicians/general practitioners (GPs), nurse practitioners (NP) and nurses with increased authority) in the emergency department (ED) triage, on patient flow outcomes.
methodsWe searched Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) (inception to January 2020). Our primary outcome was the time to provider initial assessment (PIA). Secondary outcomes included time to triage, proportion of patients leaving without being seen (LWBS), length of stay (ED LOS), proportion of patients leaving against medical advice (LAMA), number of repeat ED visits and patient satisfaction. Two independent reviewers selected studies, extracted data and assessed study quality using the National Institute for Health and Care Excellence quality assessment tool.
resultsFrom 23 973 records, 40 comparative studies including 10 randomised controlled trials (RCTs) and 13 pre-post studies were included. PHCP interventions were led by NP (n=14), GP (n=3) or nurses with increased authority (n=23) at triage. In all studies, PHCP-led intervention effectiveness was compared with the traditional nurse-led triage model. Median duration of the interventions was 6 months. Study quality was generally low (confounding bias); 7 RCTs were classified as moderate quality. Most studies reported that PHCP-led triage interventions decreased the PIA (13/14), ED LOS (29/30), proportion of patients LWBS (8/10), time to triage (3/3) and repeat ED visits (5/6), and increased the patient satisfaction (8/10). The proportion of patients LAMA did not differ between groups (3/3). Evidence from RCTs (n=8) as well as other study designs showed a significant decrease in ED LOS favouring the PHCP-led interventions.
conclusionsOverall, PHCP-led triage interventions improved ED patient flow metrics. There was a significant decrease in ED LOS irrespective of the study design, favouring the PHCP-led interventions. Evidence from well-designed high-quality RCTs is required prior to widespread implementation. PROSPERO REGISTRATION NUMBER: CRD42020148053.
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