Service use, clinical outcomes and user experience associated with urgent care services that use telephone-based digital triage: a systematic review

Abstract

ObjectiveTo evaluate service use, clinical outcomes and user experience related to telephone-based digital triage in urgent care.DesignSystematic review and narrative synthesis.Data sourcesMedline, Embase, CINAHL, Web of Science and Scopus were searched for literature published between 1 March 2000 and 1 April 2020.Eligibility criteria for selecting studiesStudies of any design investigating patterns of triage advice, wider service use, clinical outcomes and user experience relating to telephone based digital triage in urgent care.Data extraction and synthesisTwo reviewers extracted data and conducted quality assessments using the mixed methods appraisal tool. Narrative synthesis was used to analyse findings.ResultsThirty-one studies were included, with the majority being UK based; most investigated nurse-led digital triage (n=26). Eight evaluated the impact on wider healthcare service use following digital triage implementation, typically reporting reduction or no change in service use. Six investigated patient level service use, showing mixed findings relating to patients’ adherence with triage advice. Evaluation of clinical outcomes was limited. Four studies reported on hospitalisation rates of digitally triaged patients and highlighted potential triage errors where patients appeared to have not been given sufficiently high urgency advice. Overall, service users reported high levels of satisfaction, in studies of both clinician and non-clinician led digital triage, but with some dissatisfaction over the relevance and number of triage questions.ConclusionsFurther research is needed into patient level service use, including patients’ adherence with triage advice and how this influences subsequent use of services. Further evaluation of clinical outcomes using larger datasets and comparison of different digital triage systems is needed to explore consistency and safety. The safety and effectiveness of non-clinician led digital triage also needs evaluation. Such evidence should contribute to improvement of digital triage tools and service delivery.PROSPERO registration numberCRD42020178500.

A Symptom-Checker for Adult Patients Visiting an Interdisciplinary Emergency Care Center and the Safety of Patient Self-Triage: Real-Life Prospective Evaluation

“…In contrast, medical telephone triage has been extensively evaluated during A systematic review analysing 13 observational studies and 10 studies that simulated high-risk patients, safe triage was found in 46% to 97% [26]. Another systematic review involving computer-assisted telephone triage in urgent care [27] pointed out four studies that indicated potential undertriage errors [28] [29] [30] [31]. Notably, hospitalisation rates of patients who were advised to seek non-urgent care ranged from 9.2% to 48%.…”

Novel Approach to Personalized Physician Recommendations Using Semantic Features and Response Metrics: Model Evaluation Study

“…Triage service is a preliminary service in medical diagnosis [29], serving as the first point of contact for patients in healthcare. They are crucial for improving efficiency and precision of medical services.…”

The place of digital triage in a complex healthcare system: An interview study with key stakeholders in Australia's national provider

“… 2 , 6 , 7 However, research to support digital triage services reducing health service demand is equivocal; some studies have reported a reduction in service use, while others have found no change. 8 , 9 …”

“…The health benefits of these online and telephone platforms are realised only if patients and users follow the advice given, and estimates of this vary across studies and by type of advice provided; 8 , 9 , 11 for example, among users of the Healthdirect helpline that were 45 years or older, compliance was 77.5% for self-care and 68.6% for ‘attend ED immediately’, while 7.0% of callers self-referred to the emergency department (ED) within 24 hours. 12 For NHS 111, users are compliant only about half the time.…”

“… 13 Generally, users of digital triage services feel reassured and satisfied with the experience, although this also varies by the type of service and type of advice. 2 , 5 , 9 – 11 …”