Implementing remote triage in large health systems: A qualitative evidence synthesis.

Affiliation

Lewinski AA(1)(2), Rushton S(2), Van Voorhees E(3)(4), Boggan JC(3)(5), Whited JD(1)(5), Shoup JP(6), Tabriz AA(7), Adam S(8), Fulton J(3)(4), Gordon AM(1), Ear B(1), Williams JW Jr(1)(4)(5), Goldstein KM(1)(5), Van Noord MG(9), Gierisch JM(1)(5)(10).
Author information:
(1)Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
(2)School of Nursing, Duke University, Durham, North Carolina, USA.
(3)Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
(4)Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
(5)Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
(6)BJC Medical Group, St. Louis, Missouri, USA.
(7)Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy University of North Carolina, Chapel Hill, North Carolina, USA.
(8)Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
(9)Carlson Health Sciences Library, University of California, Davis, California, USA.
(10)Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.

Abstract

Remote triage (RT) allows interprofessional teams (e.g., nurses and physicians) to assess patients and make clinical decisions remotely. RT use has developed widespread interest due to the COVID-19 pandemic, and has future potential to address the needs of a rapidly aging population, improve access to care, facilitate interprofessional team care, and ensure appropriate use of resources. However, despite rapid and increasing interest in implementation of RT, there is little research concerning practices for successful implementation. We conducted a systematic review and qualitative evidence synthesis of practices that impact the implementation of RT for adults seeking clinical care advice. We searched MEDLINE®, EMBASE, and CINAHL from inception through July 2018. We included 32 studies in this review. Our review identified four themes impacting the implementation of RT: characteristics of staff who use RT, influence of RT on staff, considerations in selecting RT tools, and environmental and contextual factors impacting RT. The findings of our systemic review underscore the need for a careful consideration of (a) organizational and stakeholder buy-in before launch, (b) physical and psychological workplace environment, (c) staff training and ongoing support, and (d) optimal metrics to assess the effectiveness and efficiency of implementation. Our findings indicate that preimplementation planning, as well as evaluating RT by collecting data during and after implementation, is essential to ensuring successful implementation and continued adoption of RT in a health care system.