JMIR Publications

ABSTRACT

Background:

Telemedicine safety in general, and telephone triage' safety, in particular, have been a focus of concern since the 1970’s. Today, telehealth, now subsuming telephone triage, has formal systems with standard components intended to promote safety. However, telehealth systems may also compromise patient safety. The COVID pandemic has accelerated rapid but uneven telehealth growth technologically and professionally. Within 5-10 years, telehealth will be technologically advanced, out pacing professional standards. The need for an evidence-based foundation of system safety is crucial and urgent.

Objective:

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:

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 a 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:

A review of the literature indicates that research on various aspects of telehealth and telephone triage safety is still sparse, and 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:

Patient safety and safe practice are extremely important, while tele-triage has a high potential for error. This underregulated subspecialty, lacks adequate research in system safety. Researchers may commingle 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 growth creates urgency in identifying safe systems to guide developers and clinicians about needed improvement.