Defining emergency physicians' consultative roles in emergency care: a scoping review

Emergency physicians have a core professional responsibility to provide expert consultative advice regarding emergency medical care, but it is unclear how their consultative role manifests in health systems and whether there is potential to expand those capacities. The purpose of this study is to identify, clarify, and map key concepts related to emergency physicians acting as consultants within health systems.

This scoping review searched MEDLINE, Embase, Cochrane, CINAHL, and grey literature. No date restrictions were used and only articles in English were included. Two authors conducted screening of titles and abstracts followed by full texts independently and in duplicate. Data were narratively synthesized.

We screened 8744 articles and included 67 articles which included data from 15 countries and were published between 1974 and 2023. Emergency physicians were reported to assume three main consulting roles: (1) real-time support to other clinicians providing emergency care, (2) rapid critical medical response, and (3) response to direct referrals. The most common consultation modes were via telemedicine (56 studies), activation of hospital protocols (6 studies), and referrals to the emergency department (six studies). Few studies contextualized these roles in relation to health systems or access to emergency care.

Emergency physicians assume multiple consultative roles within health systems. We define "consultative emergency medicine" as a core competency of emergency physicians focused on the provision of advice to other care providers on individual patient care or health services for conditions that require rapid intervention to avert death or disability, or for which delays of minutes to hours render care less effective (i.e. emergency care). As emergency care develops globally, advancing "consultative emergency medicine" may be a tool to expand emergency care expertise to other providers requesting assistance with emergency care.