Streaming and redirection of lower acuity adult patients attending the ED: patient and staff experience.

Background: Streaming and redirection in the ED involves the assessment, triage and prioritisation of patients. Lower acuity patients can be streamed to alternative services within the hospital or redirected to off-site services with the aim of alleviating ED clinical pressures. This study aimed to understand staff, patient, family members and carers' experiences of streaming and redirection, including patients and staff who used an NHS web-based application.

Methods: A semistructured interview study with staff working in the ED involved in streaming delivery and adult patients and family members who had attended the ED for conditions that could be safely managed in lower acuity settings. Participants were recruited from two NHS Hospital sites in England, one using a web-based NHS urgent care self-service product (digital tool) and one using a nurse-led streaming model. Recruitment took place between August and December 2023.

Results: 28 interviews were completed. Participants across both sites commented on the challenges of streaming and redirection and confusion around where patients needed to go for what conditions. Patients and staff felt that the lack of capacity in alternative services limited the effectiveness of streaming and redirection. Three themes developed: 'it's too muddy': disruption to the flow of care, balancing privacy and efficiency in streaming and redirection, pressures in the wider healthcare system beyond the ED.

Conclusions: This research has implications for understanding patient and staff experiences of streaming and redirection approaches, and the need for clear communication and navigation when utilising digital technologies in the ED.