Original Title: [Nytta och risker av akutmottagningar med jämfört med akutmottagningar utan ansluten primärvårdsdriven närakut]

Authors' objectives: Background: Emergency department (ED) crowding is a significant challenge – i.e., the demand for emergency services surpasses the available resources for patient care within a reasonable time frame. Crowding is associated with negative outcomes such as higher mortality rates, delays in critical treatment, increased length of stay (LOS) at the ED, increased complication rates, as well as inadequate use of hospital resources. A significant number of patients seek care at the ED although their condition can be addressed by primary care. Urgent care centers (UCC) co-located and sharing triage with the ED, have been considered to reduce ED crowding and improve patient outcomes. UCCs offer care to patients with health issues that could be managed in a primary care setting. Question at issue: For adults and children contacting an ED, what are the patient benefits and risks of EDs having versus not having a co-located primary care driven UCC with shared triage? The following outcomes were considered: mortality, serious adverse event (misdiagnosis of a time-critical condition), time to physician, LOS, time to disposition decision, patient satisfaction (including communication), unplanned revisits within 72 hours, crowding, resource usage, and distribution to different care levels.

Authors' results and conclusions: Research on patient benefits and risks when comparing EDs with and without a co-located primary care driven UCC respectively is limited. Based on one retrospective study with some concerns regarding directness and study limitations, it is uncertain whether ED with UCC compared with ED without UCC leads to a difference in LOS for patients contacting the ED (GRADE ⊕OOO). No other data regarding the question at issue was found.

Authors' methods: Database searches in Medline, Embase, the Cochrane Library, Cinahl and Web of Science were performed in December 2023 and January 2024. Titles and abstracts, and subsequently full text articles, were independently screened by at least two authors, and final inclusion was decided in consensus amongst all authors. Included studies were critically appraised, and data was extracted. For outcomes for which comparative data was available, certainty of evidence was assessed using the Grading of recommendations assessment, development and evaluation (GRADE) approach.

Project Status: Completed

Year Published: 2024

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-2081313122-149/native/2024_139%20HTA-rapport%20Urgent%20Care%20Center%202024-12-10.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se