Systemic

Table 1: Interventions With Promise

Table 2: Moderate- and High-Quality Conclusive Evidence^a

ED = emergency department.
^a Interventions with certain evidence or evidence with some uncertainty (moderate or high certainty) that is moderate or high quality based on AMSTAR 2 ratings.
^b Population and setting characteristics of the individual studies that contributed to the evidence.
^c The outcome measured in the evidence with its effectiveness across the evidence. Favourable: certain evidence or evidence with some uncertainty of better effectiveness of the intervention versus a comparator. Neutral: certain evidence or evidence with some uncertainty (moderate or high certainty) that neither the intervention nor the comparator was favoured.

Table 3: New and Emerging Interventions

Intervention	Description	Implemented where?
Virtual urgent care	People seen by a virtual urgent care provider (McLeod et al.)	Ontario Ministry of Health (Ontario)
Alternate outpatient accommodation for stable, hospitalized antepartum patients	Alternative accommodations for out-of-town hospitalized pregnant people	Edmonton, Alberta
Postpartum community care program	Risk factors for postpartum hypertension ED visits for pregnant people	Calgary, Alberta
Supportive oncology care at home	Dedicated oncology-trained multidisciplinary hospital-at-home team that provides remote monitoring, hospital-at-home care, and patient information	Massachusetts General Hospital, Newton-Wellesley Hospital (US)
Outpatient parenteral antimicrobial therapy	Clinic with centralized follow-up by infectious disease physician for people who have received outpatient parenteral antimicrobial therapy	Sunnybrook Health Sciences Centre (Toronto, Ontario)
Telehealth support of elective surgery pathways	Digital app to provide patients with personalized support for people undergoing day surgeries	University of Montreal (Montreal, Quebec)
Continuous quality improvement model	Oncology Day Services staff use continuous quality improvement tools for more same-day appointments New clinic and educational resources for staff and for patients living with sickle cell disease	Juravinski Hospital and Cancer Centre (Hamilton, Ontario) Brampton, Ontario
Centralized wait lists	Literature review about wait lists to assign patients to the next available provider to improve access to care	Researchers from Canada
Accountability frameworks	Accountability from all parts of the health care system (including programs and specialists)	Authors from Canada
Mutual acculturation of hospital and ED staff	Patient handoff from the ED to other hospital services	Boston, US
Mental health EDs integrated into general EDs	Multidisciplinary teams assess and refer people with a psychiatric illness who are in crisis	Ottawa Hospital (Ottawa, Ontario)
Stepped-care mental health services	Treatment of depression and anxiety at mental health hospital hubs and community-based sites with access to services including group psychoeducation, clinician-supported internet-based cognitive behavioural therapy, self-management workbooks, or in-person psychotherapy	Structured Psychotherapy Program, Centre for Addiction and Mental Health (Ontario)
Telepsychiatry	Emergency telepsychiatry services using the province’s secure MBTelehealth network with daytime and after-hours coverage Telepsychiatry for psychiatric services in community hospitals	Winnipeg, Manitoba Vitalité Health (New Brunswick)
Mobile mental health crisis teams for youth	Youth mental health services	Sunnybrook Hospital (Toronto, Ontario)
Acute care bundle for child and youth mental health and addictions care	Patient-centred approach to caring for children and youth experiencing a mental health or addictions crisis who have been brought to the pediatric ED	Alberta
Onsite rapid-access addiction clinic	Rapid-access addiction clinic with addictions medicine assessment, medical therapy, such as opioid agonist treatment, counselling, harm reduction, and social stabilization	Edmonton, Alberta
Text messaging–supported transition for young people experiencing early psychosis	Text messaging to transition youth in ED to psychosis services, including reminders, psychoeducational resources, and check-ins	Centre for Addiction and Mental Health (Toronto, Ontario)
Assertive community treatment	Psychiatrists, nurses, social workers, and occupational therapists provide intensive case management to youth experiencing houselessness as well as early psychosis and substance use disorder, including outreach services, housing support, and integrated care	Centre Hospitalier de l’Université de Montréal (Montreal, Quebec)
Crisis intervention teams	Community-based partnerships with assessment, crisis response, and referral to reduce length of stay for people experiencing mental health challenges housed in the ED	Researcher from the US
Psychiatric care mentors	Psychiatric care team mentors support individuals experiencing houselessness	Researcher from the US
Targeted diversion programs for people experiencing houselessness	An 11-bed, 24-hour stabilization and connection centre staffed by harm reduction workers, peer support workers, case workers, and an on-call physician to offer an alternative to the ED for people experiencing houselessness and alcohol intoxication Detoxing for people experiencing houselessness	University Health Network (Toronto, Ontario) Targeted Emergency Diversion program, Ottawa Inner City Health (Ottawa, Ontario) Health Sciences North (Sudbury, Ontario)
Supportive nursing recruitment	New approach to critical care nursing recruitment and retention that focuses on mentorship, education, job sharing, and flexibility that recognizes prior work experience, responds to individual learning needs, and is supportive of new graduates entering critical care nursing practice (De Campos et al.)	London Health Sciences Centre (London, Ontario)
24/7/365 attending radiologist coverage	24/7/365 coverage by an attending radiologist to reduce ED length of stay, disposition time, and patient flow	Vancouver General Hospital (Vancouver, British Columbia)
Optimizing ED return visits for ultrasound services	Clinical pathway to help physicians determine the appropriate location (e.g., community ultrasound clinics) and timing of ultrasound services (Nair et al.)	Saskatchewan
After-hours primary care in nursing homes	Increasing after-hours access to primary care for nursing home residents	Ontario

ED = emergency department.
Note: indicates implemented in Canada.

Table 4: Inconclusive, Unfavourable, or Low-Quality Evidence

ED = emergency department.
a Population and setting characteristics of the individual studies that contributed to the evidence.
b The outcome measured in the evidence with its quality based on A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2) ratings and the effectiveness across the evidence. Inconclusive: very uncertain evidence (has low or very low certainty). Unfavourable: unfavourable effectiveness of the intervention on outcomes versus a comparator. Low quality: systematic review has a critical flaw based on AMSTAR 2 ratings and may not provide an accurate and comprehensive summary of the available studies that address the question of interest. Moderate quality: systematic review has more than 1 weakness, but no critical flaws. High quality: systematic review provides an accurate and comprehensive summary of the results of the available studies that address the question of interest. Favourable: certain evidence or evidence with some uncertainty of better effectiveness of the intervention versus a comparator. Neutral: certain evidence or evidence with some uncertainty (moderate or high certainty) that neither the intervention nor the comparator was favoured. Mixed: heterogeneous results for effectiveness of an intervention versus a comparator, and the heterogeneity is too serious to draw a conclusion. Unfavourable: unfavourable effectiveness of the intervention on outcomes versus a comparator. Inconclusive: very uncertain evidence (has low or very low certainty). No evidence: there is no evidence from primary studies.