A Prospective, Observational Study Evaluating the Impact and Safety of an Emergency Physician Collaboration With a...

Nurse triage phone lines (NTPLs) are widely used to guide patients to appropriate care levels, often relying on conservative clinical decision support systems (CDSS). This study describes the association of integrating emergency medicine physician consultation (TeleEM) with NTPL recommendations, and subsequent emergency department (ED) utilization.

From October 2020 to July 2024, a prospective, observational study was conducted across a multistate health system. TeleEM physicians reviewed NTPL cases for which nurse staff requested consultation and could agree with, upgrade, or downgrade the CDSS recommendation. Seventy-two-hour ED utilization following TeleEM consultation was also assessed.

Among 15,196 TeleEM consults, physicians agreed with the CDSS in 56% of cases, downgraded to a less urgent endpoint in 34% of cases (n = 5164), and upgraded to a more urgent endpoint in 10% of cases (n = 1517). Of downgraded patients, 32.1% (n = 1656) presented to the ED within 72 hours, and 92.2% of those were discharged from the ED. Of upgraded patients, 72.7% (n = 1,103) presented to the ED within 72 hours, and 88.5% of those were discharged from the ED. The most common ED chief complaints among downgraded patients who presented within 72 hours were chest pain (12.9%), abdominal pain (7.0%), and dizziness (4.6%).

Integrating emergency physician input into NTPL calls was associated with changes in triage disposition in >40% of cases. Among patients whose recommendations were downgraded, lower observed ED utilization was seen relative to patients whose recommendations were upgraded, although nearly one-third of downgraded patients still presented to the ED within 72 hours. These findings should be interpreted as associative rather than causal.