What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.MethodsWe have conducted a rapid framework-based evidence synthesis approach. Five separate reviews were conducted linked to themes in the NHS England review. A general and five theme specific database searches were conducted for the years 1995-2014. Relevant systematic reviews and additional primary research papers were included with narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in six months. In total 45 systematic reviews and 102 primary research studies have been included across all 5 reviews. The key findings for each reviews were 1) Demand - there is little empirical evidence to explain increases in demand for urgent care, 2) Telephone triage - Overall, these services provide , appropriate and safe decision making with high patient satisfaction but required clinical skill mix and effectiveness in a system is unclear , 3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital. 4)ED – The evidence on co-location of GP services with ED indicates there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed. 5) There is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions much of it is weak with only very small numbers of randomised controlled trials identified. Evidence is dominated by single site studies many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are 1) more detailed understanding and mapping of the characteristics of demand to inform service planning, 2) assessment of the current state of urgent care network development and evaluation of effectiveness of different models, and 3) Expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.