Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study

Abstract

Background Increasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments. Objective The purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED. Methods The study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app’s urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs). Results Of 378 participants, 344 (91%) were triaged the same or more conservatively and 34 (8.9%) were undertriaged by the app. Of the 378 patients, 14 (3.7%) had received safe advice determined by the expert panel and 20 (5.3%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all. Conclusions The app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis. Trial Registration German Clinical Trial Registration DRKS00024909; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00024909

Evaluation of Diagnostic and Triage Accuracy and Usability of a Symptom Checker in an Emergency Department: Observational Study

“…The study by Chan et al [ 35 ] (reported earlier) showed significantly better triage accuracy by their locally developed symptom checker than the patients overall (73% vs 58%; P <.01), and performance on emergency and urgent cases was stronger than on routine or home care. A recent study on the use of Ada by 378 “walk-in” patients in urgent care compared its triage accuracy with the result of a triage nurse using the Manchester Triage System [ 44 ]. The app was shown to undertriage 8.9% of cases and overtriage 57.1%, although physician assessment of the undertriaged cases suggested that 14 cases (3.7%) did not represent a risk of an adverse event.…”

A comparison of self-triage tools to nurse driven triage in the emergency department

“…Previously, online-symptom checkers have been studied with respect to their overall diagnostic and triage accuracy, but these have similarly been faced with challenges surrounding accuracy, and rates of over or under triage. [14 – 16] Artificial intelligence may also have uses in triage, with machine learning models having been demonstrated as having some success with specific presenting complaints. [17 – 19] The possibilities of how triage can evolve can take a variety of different forms, and these merit further investigation.…”

Hospitalization Risk Associated With Emergency Department Reasons for Visit and Patient Age: A Retrospective Evaluation of National Emergency Department Survey Data to Help Identify Potentially Avoidable Emergency Department Visits

“…27 Interventions have used strategies such as improving primary care access, 6 and ED diversion either before or at the time of ED visit. 28,29 In addition, there has been evidence of increasing utilization of non-ED options for receiving acute care such as urgent care centers for treatment of low-acuity conditions. 2 Identification of potentially avoidable ED visits is an important issue to consider when addressing healthcare costs and quality.…”