Comparison of Pre-Call Patient Intent to Telehealth Triage Nurse Recommended Disposition

Background: Telehealth triage is the process of directing patients to the best and safest level of medical care (disposition) based upon the acuity and severity of their symptoms. The goal of telehealth triage is to get the patient the right care, at the right place, at the right time. The changing health care landscape offers greater patient access choices about where and when to seek medical care. Comparing the level of care patients are intending to seek to a telehealth triage recommended level of care is an important consideration when reviewing care access strategies. Comparative data can help drive optimal resource allocation (cost savings) as well potentially reduce care delays (patient safety).

Methods: Patients (including caregivers and parents) phoning a large academic medical center centralized telehealth triage team during a 9-month period of calendar years 2022 through 2023 were prompted to provide their pre-call intent by a service representative during their initial call intake and after the reason for call was captured. Patients were asked what level of care they intended to seek had they not called for telehealth triage support. The patients’ pre-call intent responses were grouped for purposes of analysis into four categories: call 911, seek urgent or emergent care, call or see doctor later, and self-care at home. The triage nurses used telehealth triage guidelines for decision support, and the triage nurses’ recommendations for level of care were similarly grouped into four disposition categories. Patient pre-call intent was compared to triage nurse recommendation.

Results: Pre-call intent was obtained for 7,504 encounters (73% adult, 27% pediatric) during the study period. 42 encounters were excluded because of missing data or inability to categorize patient intent or triager recommendation. Patients reported that they would have called 911 (2.1%), sought urgent or emergent care (38.1%), sought medical care later (32.1%), or treated themselves at home (27.7%). There was poor agreement (weighted Kappa 0.140) between the patients’ pre-call intent and the triage nurses’ level of care recommendations. For encounters, the triage nurses recommended a higher (more urgent) level of care (30.5%), a lower level of care (28.3%), or the same level of care (41.2%).

Conclusion: Poor agreement was found between patients’ pre-call intent and telehealth triage nurse recommended care. Triage nurses recommended either a higher or lower level of care in approximately 6 of 10 encounters. Encounters in which the triager recommended a higher level of care have the potential for facilitating earlier intervention, improving better medical care, and promoting patient safety. Encounters in which the triager recommended a lower level of care have the potential for reducing cost and optimizing use of limited healthcare resources.