Safety and effectiveness of remote pre-hospital triage for appropriate emergency department attendances and service use
The purpose of this systematic review was to provide evidence on the safety and effectiveness of remote pre-hospital triage for reducing unnecessary emergency department (ED) attendances among adults.
Remote pre-hospital triage for unscheduled care, sorts patients into appropriate categories or triage dispositions based on how critically ill they are and can be done via telephone, video call or other online tools. Patients may be advised to attend the ED or their GP, to self-care, or dispatched an ambulance depending on perceived urgency. Undertriage occurs where patients are triaged to a lower disposition or service than what they needed. Overtriage occurs when patients are triaged too high, for example advised to attend the ED when non-urgent. General triage services sort all callers based on how urgently they need care, while specific triage services focus on ruling in or out a specific event or condition such as stroke.
The HRB found that there is a lack of strong evidence to say whether remote pre-hospital triage is safe or effective. Overall the evidence for remote pre-hospital triage was very fragmented. On closer examination, most studies of general triage services actually focused on particular symptoms or callers assigned to specificparticular triage dispositions only.
The evidence on specific triage services was of very low certainty and there were no existing reference guidelines for the conditions examined. In relation to general triage, only two studies included all users of a service, and the evidence from these was mixed and of very low certainty in relation to safety or undertriage rates, and of very low certainty in relation to effectiveness of overtriage rates. More large studies reporting on all users of general triage services, and comparing to reference guidelines, are needed in order to establish safety and effectiveness with greater certainty.
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