CJEM. 2025 Dec 6. doi: 10.1007/s43678-025-01064-4. Online ahead of print.

INTRODUCTION: We evaluated how emergency department (ED) staff perceives the practice known as redirection, whereby triage nurses guide low-acuity patients to alternative care settings without evaluation by a physician. Our aim was to evaluate its use across Canada and to identify its key drivers and barriers to its implementation.

METHODS: We conducted a cross-sectional survey of Canadian ED physicians, nurses and managers from September to December 2023. The survey tool was developed in French and English following a modified Dillman’s tailored design method, including: (1) literature review to identify key themes on redirection; (2) semi-structured interviews with experts on redirection; (3) the development of a tool prototype; (4) scientific and linguistic revisions; and (5) pre-testing. The survey was distributed through the mailing list of the Canadian emergency medicine and nursing associations.

RESULTS: Of the 719 respondents recruited, 47.0% were nurses, 44.2% were physicians and 5% were managers. The overall response rate was 10.2%. Most respondents endorsed redirection as safe, with this endorsement ranging from 75.5% in Ontario to 94.3% in Manitoba. Similarly, the view that first-line physicians can adequately manage redirected patients was supported by most respondents, with proportions ranging from 78.1% in Ontario to 92.1% in Québec. Redirection strategies reported by the majority of respondents were based on the Canadian Triage and Acuity Scale (65.2%). Insufficient opening hours of clinics (87.2%) and those with a CTAS score of 3 (62.7%) were identified as the main challenges. Professionals most suggested to receive redirected patients were family physicians (90.9%), nurse practitioners (86.4%), dentists (83.8%), social workers (71.9%), pharmacists (63.9%), and physiotherapists (58.0%).

CONCLUSIONS: In this pan-Canadian survey of ED personnel, the majority of respondents expressed support for redirecting low-acuity patients. These findings indicate an opportunity for further research on the development of redirection tools.

PubMed:41351655 | DOI:10.1007/s43678-025-01064-4