Evidence map›Paper›PMID 41714943›Full record

SynthesisBMC emergency medicine2026

Effectiveness and safety of emergency department-based streaming interventions for low-acuity utilizers - systematic review and meta-analysis.

Felix Holzinger, Konrad Schmidt, David Legg, Daniela Krüger, Cornelia Wäscher, Sylwia Steinke, Martin Möckel, Christoph Heintze, Anna Slagman, Hendrik Napierala

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Felix HolzingerCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany. felix.holzinger@charite.de.ORCID 0000-0002-8400-7757
Konrad SchmidtCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
David LeggCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Departments of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
Daniela KrügerCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Departments of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
Cornelia WäscherCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
Sylwia SteinkeCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Departments of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
Martin MöckelCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Departments of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
Christoph HeintzeCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
Anna SlagmanCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Departments of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
Hendrik NapieralaCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEmergency department (ED) crowding is a global challenge, presumably aggravated by low-acuity utilization. Various patient streaming interventions have been implemented in EDs to reduce potentially unnecessary utilization and improve care coordination and patient throughput. This systematic review examined the effectiveness and safety of ED-based streaming for low-acuity patients.

methodsA search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was conducted up to December 2, 2025. Screening and data extraction were performed in duplicate. RCTs, non-randomized controlled trials, interrupted time series, and before-after studies on general practitioner (GP) streaming, ED streaming, and urgent care (UC) streaming for low-acuity utilizers were eligible. We assessed outcomes related to care effectiveness, patient safety, and cost-effectiveness. Random-effects meta-analyses were performed. Risk of bias was assessed by the Effective Public Health Practice Project tool.

resultsWe included 137 publications reporting on 119 research projects. Meta-analyses showed higher proportions of cases managed in alternative tracks for GP streaming (0.32; CI 0.17;0.51) compared to ED streaming (0.25; CI 0.15;0.37). Both GP and ED streaming demonstrated reductions in length of stay, particularly for low-acuity patients (GP: SMD − 0.85; CI -1.37;-0.33; ED: SMD − 0.39; CI -0.56;-0.22). Safety outcomes, including leaving without being seen and unplanned ED reattendances, generally improved or were unchanged. The impact on ED utilization and cost-effectiveness remained inconclusive due to inconsistent evidence. There was high variability across outcomes, likely due to diverse context factors and multifaceted interventions.

conclusionsThis review provides a comprehensive synthesis of various ED-based streaming interventions for low-acuity patients, with effect estimation by meta-analyses. Results suggest that GP and ED streaming improve care without compromising safety, with indications of a greater potential for alternative care with GP streaming. The predominance of observational studies with potential biases and unexplained heterogeneity, however, results in very low overall certainty of the evidence. REGISTRATION: PROSPERO CRD42022355935.

Indexed as

Emergency Service, HospitalPatient SafetyCost-Benefit AnalysisCost-Effectiveness AnalysisCrowdingEmergency Room VisitsHumansEmergency departmentLow-acuity patientsMeta-analysisPatient streamingSystematic review

Identifiers

PMID41714943
PMCPMC12922365

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.