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Health services research
Original research
Service use, clinical outcomes and user experience associated with urgent care services that use telephone-based digital triage: a systematic review
  1. Vanashree Sexton,
  2. Jeremy Dale,
  3. Carol Bryce,
  4. James Barry,
  5. Elizabeth Sellers,
  6. Helen Atherton
  1. Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Vanashree Sexton; ash.sexton{at}warwick.ac.uk

Abstract

Objective To evaluate service use, clinical outcomes and user experience related to telephone-based digital triage in urgent care.

Design Systematic review and narrative synthesis.

Data sources Medline, Embase, CINAHL, Web of Science and Scopus were searched for literature published between 1 March 2000 and 1 April 2020.

Eligibility criteria for selecting studies Studies 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 synthesis Two reviewers extracted data and conducted quality assessments using the mixed methods appraisal tool. Narrative synthesis was used to analyse findings.

Results Thirty-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.

Conclusions Further 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 number CRD42020178500.

  • health services administration & management
  • quality in health care
  • organisation of health services
  • qualitative research
  • public health

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Relevant data are included in online supplemental tables.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-051569

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information. Relevant data are included in online supplemental tables.

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    Footnotes

    • Twitter @h_atherton

    • Contributors VS developed the review protocol, with the support of HA and JD. VS conducted searches. VS, CB, ES and JWNB conducted screening, data extraction and quality assessment. VS conducted the narrative synthesis with support from CB and HA. HA and JD reviewed and revised manuscript and approved the final version. VS is the guarantor for the review.

    • Funding This systematic review is part of a PhD that is funded through University of Warwick in collaboration with an industrial partner: Advanced (https://www.oneadvanced.com/).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.