Patients' self-triage for unscheduled urgent care: a preliminary study on the accuracy and factors affecting the performance of a Belgian self-triage platform

Allison Gilbert; Anh Nguyet Diep; Maryame Boufraioua; Benoit Pétré; Anne-Françoise Donneau; Alexandre Ghuysen

doi:10.1186/s12913-022-08571-5

Patients' self-triage for unscheduled urgent care: a preliminary study on the accuracy and factors affecting the performance of a Belgian self-triage platform

BMC Health Serv Res. 2022 Sep 23;22(1):1199. doi: 10.1186/s12913-022-08571-5.

Authors

Allison Gilbert¹, Anh Nguyet Diep^{2

3}, Maryame Boufraioua⁴, Benoit Pétré², Anne-Françoise Donneau^{2

3}, Alexandre Ghuysen^{4

2}

Affiliations

¹ Emergency Department, University Hospital Center, Avenue de L'Hôpital 1, 4000, Liège, Belgium. Allison.gilbert@chuliege.be.
² Public Health Department, University of Liège, Quartier Hôpital, Av. Hippocrate 13, CHU B23, 4000, Liège, Belgium.
³ Biostatistics Unit, University of Liège, Quartier Hôpital, Av. Hippocrate 13, CHU B23, 4000, Liège, Belgium.
⁴ Emergency Department, University Hospital Center, Avenue de L'Hôpital 1, 4000, Liège, Belgium.

Abstract

Background: Management of unscheduled urgent care is a complex concern for many healthcare providers. Facing the challenge of appropriately dispatching unscheduled care, primary and emergency physicians have collaboratively implemented innovative strategies such as telephone triage. Currently, new original solutions tend to emerge with the development of new technologies. We created an interactive patient self-triage platform, ODISSEE, and aimed to explore its accuracy and potential factors affecting its performance using clinical case scenarios.

Methods: The ODISSEE platform was developed based on previously validated triage protocols for out-of-hours primary care. ODISSEE is composed of 18 icons leading to algorithmic questions that finally provide an advised orientation (emergency or primary care services). To investigate ODISSEE performance, we used 100 clinical case scenarios, each associated with a preestablished orientation determined by a group of experts. Fifteen volunteers were asked to self-triage with 50 randomly selected scenarios using ODISSEE on a digital tablet. Their triage results were compared with the experts' references.

Results: The 15 participants performed a total of 750 self-triages, which matched the experts references regarding the level of care in 85.6% of the cases. The orientation was incorrect in 14.4%, with an undertriage rate of 1.9% and an overtriage rate of 12.5%. The tool's specificity and sensitivity to advise participants on the appropriate level of care were 69% (95% CI: 64-74) and 97% (95% CI: 95-98) respectively. When combined with advice on the level of urgency, the tool only found the correct orientation in 68.4% with 9.2% of undertriages and 22.4% of overtriages. Some participant characteristics and the types of medical conditions demonstrated a significant association with the tool performance.

Conclusion: Self-triage apps, such as the ODISSEE platform, could represent an innovative method to allow patients to self-triage to the most appropriate level of care. This study based on clinical vignettes highlights some positive arguments regarding ODISSEE safety, but further research is needed to assess the generalizability of such tools to the population without equity issues.

Keywords: Emergency department; Interactive platform; Self-triage; Unscheduled care.

MeSH terms

Ambulatory Care*
Belgium
Humans
Triage* / methods