Technology-based systems can facilitate remote decision-making to triage patients to the appropriate level of care. Despite technologic advances, the effects of implementation of these systems on patient and utilization outcomes are unclear. We evaluated the effects of remote triage systems on healthcare utilization, case resolution, and patient safety outcomes.
English-language searches of MEDLINE (via PubMed), EMBASE, and CINAHL were performed from inception until July 2018. Randomized and nonrandomized comparative studies of remote triage services that reported healthcare utilization, case resolution, and patient safety outcomes were included. Two reviewers assessed study and intervention characteristics independently for study quality, strength of evidence, and risk of bias.
The literature search identified 5026 articles, of which eight met eligibility criteria. Five randomized, two controlled before-and-after, and one interrupted time series study assessed 3 categories of remote triage services: mode of delivery, triage professional type, and system organizational level. No study evaluated any other delivery mode other than telephone and in-person. Meta-analyses were unable to be performed because of study design and outcome heterogeneity; therefore, we narratively synthesized data. Overall, most studies did not demonstrate a decrease in primary care (PC) or emergency department (ED) utilization, with some studies showing a significant increase. Evidence suggested local, practice-based triage systems have greater case resolution and refer fewer patients to PC or ED services than regional/national systems. No study identified statistically significant differences in safety outcomes.
Our review found limited evidence that remote triage reduces the burden of PC or ED utilization. However, remote triage by telephone can produce a high rate of call resolution and appears to be safe. Further study of other remote triage modalities is needed to realize the promise of remote triage services in optimizing healthcare outcomes.
This study was registered and followed a published protocol (PROSPERO: CRD42019112262).
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This project was funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative (ESP 09-010). This work was also supported by the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) (CIN 13-410) at the Durham VA Health Care System. The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components. Dr. Goldstein’s effort is supported by VA HSR&D CDA award no. 13-263. Dr. Van Voorhees’s effort is supported by VA Rehabilitation Research and Development CDA (1K2RX001298). Dr. Whited is supported by VA HSR&D Award SDR 16-192. Dr. Lewinski is supported by a VA OAA HSR&D PhD Fellowship TPH 21-000.
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Boggan, J.C., Shoup, J.P., Whited, J.D. et al. Effectiveness of Acute Care Remote Triage Systems: a Systematic Review. J GEN INTERN MED 35, 2136–2145 (2020). https://doi.org/10.1007/s11606-019-05585-4
- remote triage
- telephone triage
- healthcare utilization
- patient safety
- systematic review