Effectiveness of Acute Care Remote Triage Systems: a Systematic Review.
Abstract
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.<h4>Protocol
registration</h4>This study was registered and followed a published protocol (PROSPERO:
CRD42019112262).
Type
Journal articleSubject
HumansTelephone
Emergency Service, Hospital
Emergency Medical Services
Triage
Primary Health Care
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https://hdl.handle.net/10161/23331Published Version (Please cite this version)
10.1007/s11606-019-05585-4Publication Info
(2020). Effectiveness of Acute Care Remote Triage Systems: a Systematic Review. Journal of general internal medicine, 35(7). pp. 2136-2145. 10.1007/s11606-019-05585-4. Retrieved from https://hdl.handle.net/10161/23331.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Soheir Saeed Adam
Associate Professor of Medicine
Joel Boggan
Associate Professor of Medicine
I am a hospital medicine physician interested in quality improvement, patient safety,
and medical education across the UME, GME, and CME environments. My current QI and
research projects include work on readmissions, inpatient ORYX and patient experience
measures, clinical documentation improvement, medication reconciliation, and appropriate
utilization of inpatient resources. Alongside this work, I serve as the lead mentor
for our Durham VA Chief Resident in Quality and Safety within the Depart
Jessica Jade Fulton
Assistant Professor in Psychiatry and Behavioral Sciences
Clinical Practice:
I specialize in the assessment and treatment of issues common in patients and family
members of patients with chronic, life-threatening, or terminal illness focusing on
symptom management (e.g., pain, depression, anxiety) and end-of-life issues (e.g.,
suffering, anticipatory grief, existential angst). Additionally, I have expertise
in the assessment and treatment of behavioral and psychological aspects of disability
and chronic health conditions with interventions f
Jennifer M. Gierisch
Associate Professor in Population Health Sciences
Jennifer Gierisch, PhD, is behavioral scientist and health services researcher. She
is an Associate Professor in the Department of Population Heath Sciences and the Department
of Medicine at Duke University. She is a core investigator with the Center of Innovation
to Accelerate Discovery and Practice Transformation (ADAPT) where she serves as the
leader of the Partnered Research Methods Core (PRESTO) and Director of the VA OAA
Health Services Research Postdoctoral Fellowship
Karen M. Goldstein
Associate Professor of Medicine
Dr. Goldstein's research interests include women's health, cardiovascular risk reduction,
evidence synthesis methodology and peer support.
Andrzej Stanislaw Kosinski
Professor of Biostatistics & Bioinformatics
Statistical methodology for evaluation of diagnostic tests Adjustment for misclassification
Missing data Clinical trials Analysis of cardiovascular and stroke data
Allison A. Lewinski
Assistant Research Professor in the School of Nursing
I am a health services researcher with a focus on digital interventions and chronic
illness self-management. My work sits at the intersection of precision medicine and
population health. My interest in developing and implementing sustainable interventions
to improve health outcomes, and examining intervention implementation and adaptation,
is an extension of my experiences in public health and nursing. Therefore, I aim to
develop meaningful interventions that are relevant, appropriate, and can b
Sharron Rushton
Associate Clinical Professor in the School of Nursing
Sharron "Shari" Rushton, DNP, MS, RN, CCM, CNE joined the Duke University School of
Nursing (DUSON) faculty in 2011. She earned her Bachelor of Science in Nursing from
the University of Iowa, a Master of Biomedical Science in Physiology from the Mayo
Graduate School, and both an Master of Science in Nursing and Doctor of Nursing Practice
from DUSON.
She has several years of clinical experience in various roles including staff nurse
and nursing administration. Clinical
Elizabeth E. Van Voorhees
Assistant Professor in Psychiatry and Behavioral Sciences
Interest in understanding mechanisms and advancing treatment of anger and aggression
in veterans with trauma-related psychopathology, including posttraumatic stress disorder.
Specific interests in integrating mHealth applications and sensor technology into
the therapeutic process; sex/gender differences in the experience, expression, and
treatment of anger and aggression associated with trauma; and “moral injury”
associated with trauma.
John Wiley Williams Jr.
Professor of Medicine
John Williams, MD, MHS, is a Professor of Medicine at Duke University Medical Center
and a past recipient of VA Health Services Career Development and a Robert Wood Johnson
Foundation Generalist Faculty Scholar Awards. He received his bachelor and MD degrees
from the University of North Carolina. Dr. Williams completed residency training at
the University of Iowa and a research fellowship at Duke University. He is a primary
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