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Table 1: Interventions With Promise

ED = emergency department.

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

ED = emergency department; EMS = emergency medical services.
^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?
Mobile integrated health response teams	Local community groups deliver patient-centred visits at home Community paramedics receive extra training to provide short-term management safely to people in the community with low-acuity illnesses Researchers try to prevent ED visits and hospital admissions for people living in nursing homes	Niagara Emergency Medical Services (Thorold, Ontario) Alberta Italy
Neighbourhood model	Personal support workers are employed with full-time salaries to deliver more frequent and personalized care in the community, including onsite cleaners for housekeeping, personal support (e.g., dressing, taking medications), crisis intervention, and personal care (e.g., bathing)	St. Joseph’s Home Care Neighbourhood Model for Seniors at Risk (Hamilton, Ontario)
Community support teams	A program in northern communities for people experiencing intellectual and developmental disabilities or mental illness that provides crisis support, assessments, relationship building between families and services, support to individuals moving from hospital to the community, and help for clients accessing the services they need	Alberta
Rapid access to diagnostic testing and IV therapy in long-term care	Timely access to diagnostic testing and IV therapy to reduce the need for ED services for people living in long-term care	Ontario
Same-day physician access in long-term care	Timely access to physicians to reduce the need for ED services for people living in long-term care	Ontario
Nurse-led shared medical appointments	Nurse-led shared appointments to improve access to care for people with gastroesophageal reflux disease, dyspepsia, and irritable bowel syndrome	Calgary, Alberta
Attract Connect Stay model	Community-centred, strengths-based approaches to rural clinician recruitment and retention with support from a Health Workforce Recruiter Connector	Marathon, Ontario, and Australia
Community pharmacy primary care clinics	Pharmacist-led primary care clinics in communities with the highest number of people without a family doctor	Nova Scotia Health and the Pharmacy Association of Nova Scotia (Nova Scotia)
Embedded physician assistants in rural and remote primary care	As part of a rural and remote clinician retention strategy, physician assistants are embedded in primary health care teams in remote areas	Ongomiizwin Health Services (Winnipeg, Manitoba)
Real-time virtual support for rural physicians	Connecting rural care providers, such as physicians, nurses, and midwives, to a network of on-call peers with real-time virtual care services (e.g., Zoom or phone). No cost to practitioners in rural, remote, and First Nations communities across the province for all urgent and low-acuity cases offering peer support for specialist consultations, second opinions, and ongoing patient support	Rural Coordination Centre of British Columbia (British Columbia)
Remote monitoring and home health monitoring	People receive home health monitoring kit with touch screen tablet computer to measure blood pressure, oxygen saturation, and body weight, and so on. People submit daily biometric measurements and responses to questions about their symptoms which alerts a monitoring nurse who provides self-management education and advance care planning.	TEC4HOME Heart Failure (British Columbia) TEC4Home COPD (British Columbia)
QR codes to increase use and distribution of discharge instructions	Staff use QR codes to help patients access discharge instructions and resources (Cheng et al.)	Vancouver General Hospital (Vancouver, British Columbia)
Quality improvement in palliative oncology	Improving access to after-hours hospital and home care for people receiving palliative care	Odette Cancer Centre (Toronto, Ontario)
RELIEF digital health app	Patients receiving palliative care through an app to self-report daily symptoms and communicate with the care team to ensure timely adjustments in care to remain at home; care team is triggered by alerts to determine if ED visit is needed	Brampton Civic Hospital (Brampton, Ontario)
Used cellphone program for people experiencing houselessness	Prepaid cell phones are donated to people who are experiencing houselessness, are experiencing mental health or substance use challenges, or are socially isolated	University Health Network (Toronto, Ontario)
Mobile apps to reduce hospital readmissions after surgery	A mobile app to support thoracic surgery patients and families during initial discharge phase of home care, including education, self-care reminders, symptom surveys, and monitoring and alerts to a nurse Mobile app for self-assessment of signs of surgical site infection following colorectal surgery Mobile app to reduce readmissions after colorectal surgery	St. Joseph’s Health Care Hamilton (Hamilton, Ontario) Ottawa Hospital (Ottawa, Ontario) Mount Sinai Hospital (Toronto, Ontario)
HEARTSMAP for children and youth experiencing mental health challenges	Electronic tool to support physicians with psychosocial assessments and disposition decision-making for children experiencing mental health challenges	BC Children’s Hospital (Vancouver, British Columbia)
Community hospital–based heart function clinics	Individuals referred to the local community hospital heart function clinic	Central Local Health Integration Network (Ontario)
ED return visit quality program	Quality improvement program that mandates large EDs in the province to conduct chart audits of patients who return within 72 hours and are admitted to hospital or return within 7 days with acute myocardial infarction, subarachnoid hemorrhage, or pediatric sepsis and are admitted to hospital 72-hour readmission audit and feedback	Emergency Department Return Visit Quality Program (Ontario) Calgary
ED avoidance classification	Retroactive assessment of ED charts with a standardized tool to determine whether patients could have been cared for virtually or in an alternate subacute setting	Hamilton, Ontario
Housing placement intervention to reduce ED readmissions	Program that connects individuals to housing (e.g., shelters, room and board, or board and care) upon discharge from the ED	California, US
Surge management and prediction	Quality improvement initiative using ED and hospital data to apply real-time protocols to manage surges in ED visits and reduce ED lengths of stay Patient flow simulation exercises used to help decide where to offload ambulance arrivals and transfer patients needing a bed Machine learning algorithm predicts patient surges in ED waiting room Machine learning algorithm predicts ED visits and surges	Newfoundland and Labrador St. Catherine’s Hospital (St. Catherine’s, Ontario) The Hospital for Sick Children (Toronto, Ontario) St. Michael’s Hospital (Toronto, Ontario)
Forecasting daily attendance at EDs	Forecasting models to predict daily demand for ED services ED crowding warning system intended to provide real-time hourly predictions	Lille, France Finland
Clinical roles for emergency medical communications centres	Clinicians supporting emergency medical services staff in patient triage, advice, referral to nonemergency care, and peer-to-peer counselling	Dalhousie University (Halifax, Nova Scotia)
PriCARE patient classification for potentially preventable ED visits by ambulance transport	Protocols for ambulances to transport patients with nonemergent conditions to other facilities instead of EDs	Ontario
Real-time wait time reporting	Reporting and displaying real-time ED wait times	Canada
Virtual pediatric ED visits	Virtual pediatric ED embedded into hospital electronic medical record Video-based telemedicine to reduce safety issues and provide timely care	Children’s Hospital of Eastern Ontario (Ottawa, Ontario) Montreal Children’s Hospital (Montreal, Quebec)
Minor injury ED appointment bookings	Pilot project for the public to book same-day or next-day ED arrival time and complete assessment questionnaire for treatment of minor injuries	Royal Victoria Regional Health Centre (Barrie, Ontario)

ED = emergency department; QR = quick response.
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.