Original Title: État des connaissances - Les zones d’évaluation rapide dans les urgences : caractéristiques organisationnelles et impacts

Authors' objectives: Within the Quebec network, several hospitals have already set up a RAZ in their emergency unit. Ministerial guidelines published in 2021 also provide a frame of reference for the organization and operation of such a zone. However, implemented RAZs remain highly heterogeneous from one facility to another. With the aim of improving the coherence and fluidity of care in the network, the MSSS has mandated the INESSS to produce a review of the current state of knowledge regarding: • the inclusion and exclusion criteria to be recommended within a RAZ (i.e., users' age, history, or health conditions); • RAZ organizational and operational modalities to be considered in various contexts; • the impact of RAZs on: – the safety of patients installed in these zones; – the health and well-being of users; and – the efficiency of the care offered.

Authors' results and conclusions: RESULTS: (#1 ORGANIZATIONAL AND OPERATIONAL MODELS): Regarding RAZ nomenclature: • According to the data collected, there is considerable heterogeneity among the terms used to designate RAZs. • The most common term was "rapid assessment zone", followed by "split flow"4, and "fast track". • Several studies also used an umbrella term (i.e. streaming interventions), which describes all RAZ models that divide patients into homogeneous groups based on common conditions. International distinctions are also noteworthy: • In the UK, "rapid assessment and treatment" is a model analogous to the RAZ, however it is not an area physically designated within the emergency unit. Instead, it is a process which involves a specific medical team. This approach removes triage from the emergency department pathway. • France has a particular RAZ model (i.e. the immediate care medical center), which is not physically integrated into the emergency departments. (#2 PROMISING IMPACT ): Most currently available data report positive results regarding various performance and safety indicators: • A reduction in the rate of patients who leave without seeing a medical provider (-10.6% to -0.8%) (moderate to high quality); • A reduction in the length of stay (-42% to -4%) (moderate quality); • A reduction in wait times (-63% to -9%) (moderate to high quality). (#3 SHORTCOMINGS IN THE LITERATURE): Further research is needed to shed light on the following topics: • Out of the 26 studies reviewed, only 5 of them analyzed pediatric emergency departments. None of the articles reviewed focused specifically on the elderly. • Current available data concerning the impact of RAZs on quality of care, ambulance diversion and economic indicators is limited, making it difficult to draw conclusions on those parameters. Moreover, none of the studies included in this review analyzed the cost-benefit or cost-utility of RAZ models. • No evidence was found regarding the impact of RAZs on clinical indicators (e.g., patient mortality and morbidity). (#4 LIMITATIONS): The studies included in this review are mainly observational, and a causal relationship between RAZs and their impact on various indicators cannot be inferred. • Sustainability of the ED’s organizational gains over time has rarely been assessed. • Few studies have controlled for potential confounders. • Some publication bias may be present for indicators that were assessed based on limited available data. • The heterogeneity of terms used to designate RAZs could have led to the omission of publications that used other designations. CONCLUSION: This review provides an overview of the evidence currently available on RAZs. Although the evidence does not point to a single model to be recommended, it does highlight certain elements that could help clarify ministerial guidelines on the implementation and management of rapid assessment zones in Quebec. In addition, an evaluation of implementation processes could provide a better understanding of the impact of RAZs in the Quebec context.

Authors' methods: A rapid review of the scientific and grey literature investigating the evaluation dimensions named above was conducted for all publications produced since the year 2015.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/les-zones-devaluation-rapide-dans-les-urgences-caracteristiques-organisationnelles-et-impacts.html

Year Published: 2023

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/les-zones-devaluation-rapide-dans-les-urgences-caracteristiques-organisationnelles-et-impacts.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)