JMIR Publications

ABSTRACT

Background:

Background:

The safety of Telemedicine in general, and telephone triage' safety, in particular, have been a focus of concern since the 1970s. Today, telehealth, now subsuming telephone triage, has a basic structure and process, intended to promote safety. However, inadequate telehealth systems may also compromise patient safety. The COVID pandemic accelerated rapid but uneven telehealth growth, both technologically and professionally. Within 5-10 years, the field will likely be more technologically advanced, however, these advances may still outpace professional standards. The need for an evidence-based system is crucial and urgent.

Objective:

Aim: Our aim was to explore ways that developed tele-triage systems produce safe outcomes, by examining key system components and questioning long-held assumptions.

Methods:

Methods:

We performed a systems analysis of two systems’ respective approaches to safety. We examined safety by performing a review of the literature, using key terms concerning patient safety in Tele-triage. In addition, we conducted system analysis of two typical types of formal systems – physician-led and nurse-led, in Israel and the U.S., respectively. Additionally, we conducted in-depth interviews with representative physicians and one nurse.

Results:

Results:

A review of literature indicates that research on various aspects of telehealth and telephone triage safety is still sparse, of variable quality, producing conflicting and inconsistent results. Researchers, possibly unfamiliar with this complicated field, use an array of poorly defined terms, and appear to design studies based on unfounded assumptions. The interviews with healthcare professionals demonstrated the challenges encountered during tele-triage.

Conclusions:

Conclusions:

Remote encounters about acute, worrisome symptoms are time-sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important, in the field of tele-triage, which has a high potential for error. This underregulated subspecialty lacks adequate development and substantive research in system safety. Researchers may commingle terminology as well as widely different ill-defined groups of decision-makers with wide variation in decision-making skills, clinical training, experience, and job qualifications, thereby confounding results. The rapid pace of telehealth’s’ technological growth creates urgency in identifying safe systems to guide developers and clinicians about needed improvements.