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Effectiveness of Acute Care Remote Triage Systems: a Systematic Review.

Publication ,  Journal Article
Boggan, JC; Shoup, JP; Whited, JD; Van Voorhees, E; Gordon, AM; Rushton, S; Lewinski, AA; Tabriz, AA; Adam, S; Fulton, J; Kosinski, AS ...
Published in: J Gen Intern Med
July 2020

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. PROTOCOL REGISTRATION: This study was registered and followed a published protocol (PROSPERO: CRD42019112262).

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

July 2020

Volume

35

Issue

7

Start / End Page

2136 / 2145

Location

United States

Related Subject Headings

  • Triage
  • Telephone
  • Primary Health Care
  • Humans
  • General & Internal Medicine
  • Emergency Service, Hospital
  • Emergency Medical Services
  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences
 

Citation

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Boggan, J. C., Shoup, J. P., Whited, J. D., Van Voorhees, E., Gordon, A. M., Rushton, S., … Gierisch, J. M. (2020). Effectiveness of Acute Care Remote Triage Systems: a Systematic Review. J Gen Intern Med, 35(7), 2136–2145. https://doi.org/10.1007/s11606-019-05585-4
Boggan, Joel C., John Paul Shoup, John D. Whited, Elizabeth Van Voorhees, Adelaide M. Gordon, Sharron Rushton, Allison A. Lewinski, et al. “Effectiveness of Acute Care Remote Triage Systems: a Systematic Review.J Gen Intern Med 35, no. 7 (July 2020): 2136–45. https://doi.org/10.1007/s11606-019-05585-4.
Boggan JC, Shoup JP, Whited JD, Van Voorhees E, Gordon AM, Rushton S, et al. Effectiveness of Acute Care Remote Triage Systems: a Systematic Review. J Gen Intern Med. 2020 Jul;35(7):2136–45.
Boggan, Joel C., et al. “Effectiveness of Acute Care Remote Triage Systems: a Systematic Review.J Gen Intern Med, vol. 35, no. 7, July 2020, pp. 2136–45. Pubmed, doi:10.1007/s11606-019-05585-4.
Boggan JC, Shoup JP, Whited JD, Van Voorhees E, Gordon AM, Rushton S, Lewinski AA, Tabriz AA, Adam S, Fulton J, Kosinski AS, Van Noord MG, Williams JW, Goldstein KM, Gierisch JM. Effectiveness of Acute Care Remote Triage Systems: a Systematic Review. J Gen Intern Med. 2020 Jul;35(7):2136–2145.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

July 2020

Volume

35

Issue

7

Start / End Page

2136 / 2145

Location

United States

Related Subject Headings

  • Triage
  • Telephone
  • Primary Health Care
  • Humans
  • General & Internal Medicine
  • Emergency Service, Hospital
  • Emergency Medical Services
  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences