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Ease pediatric emergency department crowding in Switzerland with high-quality telephone triage: a prospective
Krisztina Schmitz-Grosz1, Carsten Sommer-Meyer1, Stéphanie van der Lely1
1Medgate, Basel, Switzerland.
Insights
This study shows pediatric telephone triage services (PTTS) are effective, safe, and satisfactory for patients, reducing emergency department visits. PTTS improves pediatric emergency care quality and efficiency.
Area of Science:
- Healthcare Management
- Telemedicine
- Pediatric Emergency Medicine
Background:
- Pediatric emergency departments face significant burdens.
- Telephone triage services offer a potential solution to manage patient flow and optimize care.
- Evaluating the quality of pediatric telephone triage services (PTTS) from multiple perspectives is crucial.
Purpose of the Study:
- To assess the quality of a pediatric telephone triage service (PTTS) from hospital, telemedical, and patient viewpoints.
- To understand PTTS's contribution to alleviating the pediatric emergency care burden.
- To evaluate the appropriateness, safety, and efficiency of telemedical triage.
Main Methods:
- Prospective multicenter study involving calls to a pediatric telephone triage service in Switzerland.
- Evaluation of telemedical triage appropriateness by hospital triage specialists and telemedical peer-review.
- Assessment of patient intention, adherence to recommendations, and satisfaction.
Main Results:
- The PTTS appropriately triaged 78.2% of cases from the hospital perspective, increasing to 91.7% after telemedical review.
- Undertriage rates were 8.1% (hospital) and 3.8% (telemedical), while overtriage rates were 13.7% (hospital) and 4.5% (telemedical).
- Patient adherence to triage recommendations was high for Pediatric Emergency Department (PED) and telemedicine referrals (84.1% and 83.5%), but lower for Primary Care Provider (PCP) referrals (23.3%).
Conclusions:
- The studied PTTS is appropriate, safe, efficient, and patient-satisfactory, significantly reducing unnecessary Pediatric Emergency Department visits.
- High patient adherence to PED and telemedicine recommendations suggests effective service utilization.
- Lower adherence to PCP referrals may indicate challenges in parental perception of urgency or PCP accessibility, warranting further investigation.
Introduction:
This is the first study evaluating the picture of a pediatric telephone triage service's (PTTS) quality from the hospital, telemedical, and patient perspective, to provide a deeper understanding of its contribution to the relief of pediatric emergency burden.
Methods:
We conducted a prospective multicenter study from April 3 to May 15, 2023. All calls to the Medgate Kids Line of six hospitals providing pediatric emergency care in German-speaking Switzerland were included. Following telemedical counselling, patients were advised to visit a pediatric emergency department (PED) or a primary care provider (PCP) or were treated telemedically by the Kids Line team. Patients presenting to participating PEDs after calling were evaluated by a hospital triage specialist (HTS) to define telemedical triage's appropriateness [appropriate triage, undertriage (safety), overtriage (efficiency); hospital perspective]. Only PED presentations evaluated as undertriage or overtriage were peer-reviewed (telemedical perspective), while appropriate triages were adopted. Additionally, patients' intention, adherence and satisfaction were assessed.
Results:
We included 4,061 calls. 24.9% cases were advised to go to a PED, 20.7% to a PCP, and 54.3% were allocated to telemedicine. HTSs evaluated 556 cases. The PTTS appropriately triaged 78.2% of cases according to the hospital perspective (undertriage: 8.1%; overtriage: 13.7%). After telemedical peer-review overall appropriateness was 91.7% (undertriage: 3.8%; overtriage: 4.5%). 606 patients provided feedback. Without PTTS, 76.9% would have consulted face-to-face medical care (PED: 60.6%). Adherence to triage recommendation was mostly high (PED: 84.1%; PCP: 23.3%; Telemedicine: 83.5%). Net promoter score was high (48.5).
Conclusion:
This PTTS (>100,000 calls/year) based on clinical expertise and guidelines is appropriate, safe, efficient, and patient-satisfactory and prevents a considerably high percentage of patients from visiting a PED. While patient adherence to triage recommendations "PED" and "Telemedicine" was high, lower adherence to PCP referrals might be explained by deviations in parents' perception of acuity, and/or limited PCP availability (at out-of-office hours). Triage appropriateness varied across perspectives. Incorporating such high-quality PTTSs into further regions of Switzerland may help alleviate the burden on the healthcare system.
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