Safety in Teletriage by Nurses and Physicians in the US and Israel - a Tale of 2 Systems

Abstract Background The safety of telemedicine in general and telephone triage (teletriage), in particular, have been a focus of concern since the 1970s. Inadequate telehealth systems may compromise patient safety. Objectives Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. Methods We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems’ respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. Results The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering non-medical factors and patient preferences (Shared Decision-Making). Conclusions Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. There is a need identifying safe systems to guide developers and clinicians about needed improvements. Key messages • Patient safety and safe professional practice are extremely important in the field of teletriage. • We need to guide developers and clinicians about needed improvements in teletriage systems.