Table 6, Review protocol: Matron/nurse-led care versus usual care from EVIBASE - Emergency and acute medical care in over 16s: service delivery and organisation

Review question	Alternatives to acute care in hospital
Guideline condition and its definition	Acute Medical Emergencies. Definition: A medical emergency can arise in anyone, for example, in people: without a previously diagnosed medical condition, with an acute exacerbation of underlying chronic illness, after surgery, after trauma.
Objectives	To determine if wider provision of community-based intermediate care prevents people from staying in hospitals longer than necessary while not impacting on patient and carer outcomes.
Review population	Adults and young people (16 years and over) with a suspected or confirmed AME or patients at risk of AME.
	Adults (17 years and above). Young people (aged 16-17 years).
	Line of therapy not an inclusion criterion.
Interventions and comparators: generic/class; specific/drug (All interventions will be compared with each other, unless otherwise stated)	Community matron or Nurse-led care. Hospital-based care/services. Usual Care.
Outcomes	- Quality of life at during study period (Continuous) CRITICAL - Length of hospital stay at during study period (Continuous) - Mortality at during study period (Dichotomous) CRITICAL - Avoidable adverse events at during study period (Dichotomous) CRITICAL - Patient and/or carer satisfaction at during study period (Dichotomous) CRITICAL - Number of presentations to Emergency Department at during study period (Dichotomous) - Number of admissions to hospital at After 28 days of first admission (Dichotomous) - Number of GP presentations at during study period (Dichotomous) - Readmission up to 30 days (Dichotomous)
Study design	Systematic reviews (SRs) of RCTs, RCTs, observational studies only to be included if no relevant SRs or RCTs are identified.
Unit of randomisation	Patient.
Crossover study	Permitted.
Minimum duration of study	Not defined.
Population stratification	Early discharge. Admission avoidance.
Reasons for stratification	Each of them targets a separate outcome: early discharge would be primarily aimed at reducing length of stay, while admission avoidance would be primarily aimed at reducing hospital admission. Also, the population would be different as the admission avoidance group could be managed at home for the whole episode of care (they could be cared for at home from the start) while the early discharge group needs to be “stabilised” at hospital first then discharged.
Subgroup analyses if there is heterogeneity	- Frail elderly (frail elderly; not frail elderly); Different from younger population.
Search criteria	Databases: Medline, Embase, the Cochrane Library, CINAHL. Date limits for search: No date limits. Language: English only.

Review question

Alternatives to acute care in hospital

Guideline condition and its definition

Acute Medical Emergencies. Definition: A medical emergency can arise in anyone, for example, in people: without a previously diagnosed medical condition, with an acute exacerbation of underlying chronic illness, after surgery, after trauma.

Objectives

To determine if wider provision of community-based intermediate care prevents people from staying in hospitals longer than necessary while not impacting on patient and carer outcomes.

Review population

Adults and young people (16 years and over) with a suspected or confirmed AME or patients at risk of AME.

Adults (17 years and above).

Young people (aged 16-17 years).

Line of therapy not an inclusion criterion.

Interventions and comparators: generic/class; specific/drug

(All interventions will be compared with each other, unless otherwise stated)

Community matron or Nurse-led care.

Hospital-based care/services.

Usual Care.

Outcomes

-: Quality of life at during study period (Continuous) CRITICAL
-: Length of hospital stay at during study period (Continuous)
-: Mortality at during study period (Dichotomous) CRITICAL
-: Avoidable adverse events at during study period (Dichotomous) CRITICAL
-: Patient and/or carer satisfaction at during study period (Dichotomous) CRITICAL
-: Number of presentations to Emergency Department at during study period (Dichotomous)
-: Number of admissions to hospital at After 28 days of first admission (Dichotomous)
-: Number of GP presentations at during study period (Dichotomous)
-: Readmission up to 30 days (Dichotomous)

Study design

Systematic reviews (SRs) of RCTs, RCTs, observational studies only to be included if no relevant SRs or RCTs are identified.

Unit of randomisation

Patient.

Crossover study

Permitted.

Minimum duration of study

Not defined.

Population stratification

Early discharge.

Admission avoidance.

Reasons for stratification

Each of them targets a separate outcome: early discharge would be primarily aimed at reducing length of stay, while admission avoidance would be primarily aimed at reducing hospital admission. Also, the population would be different as the admission avoidance group could be managed at home for the whole episode of care (they could be cared for at home from the start) while the early discharge group needs to be “stabilised” at hospital first then discharged.

Subgroup analyses if there is heterogeneity

-: Frail elderly (frail elderly; not frail elderly); Different from younger population.

Search criteria

Databases: Medline, Embase, the Cochrane Library, CINAHL.

Date limits for search: No date limits.

Language: English only.

From: Chapter 9, Community nursing

Emergency and acute medical care in over 16s: service delivery and organisation.

NICE Guideline, No. 94.

National Guideline Centre (UK).

London: National Institute for Health and Care Excellence (NICE); 2018 Mar.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 6Review protocol: Matron/nurse-led care versus usual care from EVIBASE