Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 23, 2021
Open Peer Review Period: Jul 23, 2021 - Sep 17, 2021
Date Accepted: Feb 18, 2022
(closed for review but you can still tweet)
Safety of triage self-assessment using a symptom assessment application for walk-in patients in the emergency care setting: an observational prospective cross-sectional study
ABSTRACT
Background:
Increasing utilization of emergency departments (EDs) by patients with low urgency combined with limited availability of medical staff results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments.
Objective:
The purpose of this study was to evaluate the safety of urgency advice provided by a symptom assessment application (SAA), Ada, in an Emergency Department.
Methods:
The study was carried out at the interdisciplinary Emergency Department of Marburg University Hospital with data collection between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design with 378 patients included. The app's urgency recommendation was compared to an established triage concept (Manchester Triage System, MTS), including patients from the lower three MTS categories only. For all under-triaged patients, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHS).
Results:
Of 378 participants, 91.0%(344/378) were triaged the same or more conservative, 9.0%(34/378) were under-triaged by the app. Of the latter, 3.7%(14/378) had received safe advice determined by the expert panel and 5.3%(20/378) were considered potential AHS. Therefore, the assessment could be considered safe in 94.7%(358/378) when compared to the MTS assessment. From the three lowest MTS categories, 43.4%(164/378) of patients were not considered emergency cases by the application, but could have been safely treated by a general practitioner or would not have require a physician consultation at all.
Conclusions:
The app provided urgency advice after patient ‘self-triage’ that has a high rate of safety and a rate of under-triage and a rate of triage with potential to be an AHS equivalent to telephone triage by Health care professionals (HCPs) while still being more conservative than direct ED triage. A large proportion of ED patients were not considered emergency cases which could possibly relieve emergency department burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis. Clinical Trial: German Clinical Trial Registration DRKS00024909, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024909
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