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

Problem

Telephone based digital triage is widely used by services that provide urgent care. This involves a call handler or clinician using a digital triage tool to automatically generate care advice, based on a patient’s symptoms. Despite wide adoption, there is limited evaluation of its impact on service user experience, service use and clinical outcomes. No previous systematic reviews have focussed on these outcomes in the urgent out of hours care setting.

Approach

Studies were identified through searches conducted in Medline, Embase, CINAHL, Web of Science and Scopus. All original study types were included. Quality assessment of studies was conducted using the Mixed Methods Appraisal Tool (MMAT); narrative synthesis was used to analyse findings.

Findings

Thirty one studies were included, most evaluated clinician led triage (n =26) and were of quantitative design (n=25). Studies evaluated change service use (including primary care, emergency department use, ambulance use, and emergency hospital admissions) following digital triage implementation; typically they reported a reduction or no change in service use. Studies that evaluated patient level service use showed mixed findings relating to patients’ subsequent service use and adherence with triage advice. Aside from hospitalisation rates of digitally triaged patients, no studies reported on clinical outcomes. Three studies highlighted potential triage inconsistencies relating to under-triage. Digital triage service users reported good satisfaction overall; two key themes related to callers’ need for assertiveness in order to receive care that they felt was appropriate and improved experience where services worked together.

Consequences

Interpreting success of digital triage is complex, with varying service level factors and varying health care systems internationally. There was no evidence of differences in safety or user experience between clinician and non-clinician led digital triage, meaning that this could be an effective model for countries to adopt. However, only four of the included studies investigated non-clinician led digital triage, and therefore further research into non-clinician led triage is important.Digital triage is central to telephone based care delivery, which is vital during pandemic situations. Further research into the following areas will help to improve digital triage tools and service delivery: 1) patient level service use and clinical outcomes related to digital triage, in order to better understand safety and potential triage inconsistencies 2) the effectiveness of non-clinician led digital triage and 3) more qualitative and mixed methods approaches to better understand patients’ adherence with triage advice and care needs in depth, which can feed into how service delivery can be improved.