How Healthcare Providers Decide on a Referral Location in Telephone Triage: A Cross-sectional Study

Area of Science:

• Healthcare Management
• Clinical Decision-Making
• Medical Triage

Background:

• ~25% of emergency department (ED) visits follow prior healthcare professional contact.
• Many patients could be managed in non-ED ambulatory settings, improving ED flow and patient experience.
• Understanding provider triage decision-making is crucial for optimizing care pathways.

Purpose of the Study:

• To evaluate healthcare provider thought processes in patient triage.
• To identify factors influencing triage decisions for patient calls.

Main Methods:

• Cross-sectional survey study using hypothetical clinical scenarios.
• Participants included internal medicine, family medicine, and emergency medicine providers.
• Qualitative analysis of free-response data identified key themes and influencing factors.

Main Results:

• Significant variability in triage decisions was observed across providers and cases.
• Attending physicians triaged fewer patients to the ED compared to residents (p<0.001).
• Qualitative data revealed complex cognitive processes and influencing factors in triage.

Conclusions:

• Provider triage decisions are multifactorial, involving clinical resources, care coordination, patient, and clinician factors.
• Variability in triage decisions is not fully explained by physician characteristics alone.
• A novel conceptual model for cognitive triage was developed.