Impact of a telephone triage service for non-critical emergencies in Switzerland: A cross-sectional study

Safety of patient self-triage: real-life prospective evaluation of a symptom-checker in adult patients visiting an interdisciplinary emergency care center

BACKGROUND

Symptom-checkers have become important tools for self-triage, assisting patients to determine the urgency of medical care. To be safe and effective, these tools must be validated, particularly to avoid potential hazardous undertriage without leading to inefficient overtriage. Only limited safety data from studies including small sample sizes have been available so far.

OBJECTIVE

The objective of our study was to prospectively investigate the safety of patients' self-triage in a large patient sample. We used SMASS pathfinder, a symptom-checker based on a computerized transparent neural network.

METHODS

We recruited 2543 patients into this single centre, prospective clinical trial conducted at the cantonal hospital of Baden, Switzerland. Patients with an Emergency Severity Index of 1-2 were treated by the team of the emergency department, while those with an index of 3-5 were seen at the walk-in clinic by general physicians. We compared the triage recommendation obtained by the patients' self-triage with the assessment of the clinical urgency made by three successive interdisciplinary panels of physicians (Panel A, B, C). Using a Clopper-Pearson confidence interval, we assumed that in order to confirm the symptom-checkers safety, the upper confidence bound for the probability of a potentially hazardous undertriage should lie below 1%. A potentially hazardous undertriage was defined as a triage in which either all (consensus criterion) or the majority (majority criterion) of the experts of the last panel (Panel C) rated the triage of the symptom-checker to be "rather likely" or "likely" life-threatening or harmful.

RESULTS

Of the 2543 patients, 1227 (48.3%) were female and 1316 (51.7%) male. None of the patients reached the pre-specified consensus criterion for a potentially hazardous undertriage. This resulted in an upper 95% confidence bound of 0.1184%. 4 cases met the majority criterion. This resulted in an upper 95% confidence bound for the probability of a potentially hazardous undertriage of 0.3616%. The two-sided 95% Clopper-Pearson confidence interval for the probability of overtriage (450 cases, 17.7%) was 16.23% to 19.24%, which is considerably lower than figures reported in the literature.

CONCLUSIONS

The symptom-checker proved to be a safe triage tool, avoiding potentially hazardous undertriage in a real-life clinical setting of emergency consultations at a WIC/ED, whithout causing undesirable overtriage. Our data suggest the symptom-checker may be safely used in clinical routine.

CLINICALTRIAL

ClinicalTrials.gov identifier NCT04055298.

www.coronabambini.ch: Development and usage of an online decision support tool for paediatric COVID-19-testing in Switzerland: a cross-sectional analysis

OBJECTIVES

To describe the development and usage of www.coronabambini.ch as an example of a paediatric electronic public health application and to explore its potential and limitations in providing information on disease epidemiology and public health policy implementation.

DESIGN

We developed and maintained a non-commercial online decision support tool, www.coronabambini.ch, to translate the Swiss Federal Office of Public Health (FOPH) paediatric (age 0-18 years) COVID-19 guidelines around testing and school/daycare attendance for caregivers, teachers and healthcare personnel. We analysed the online decision tool as well as a voluntary follow-up survey from October 2020 to September 2021 to explore its potential as a surveillance tool for public health policy and epidemiology.

PARTICIPANTS

68 269 users accessed and 52 726 filled out the complete online decision tool. 3% (1399/52 726) filled out a voluntary follow-up. 92% (18 797/20 330) of users were parents.

RESULTS

Certain dynamics of the pandemic and changes in testing strategies were reflected in the data captured by www.coronabambini.ch, for example, in terms of disease epidemiology, gastrointestinal symptoms were reported more frequently in younger age groups (13% (3308/26 180) in children 0-5 years vs 9% (3934/42 089) in children ≥6 years, χ²=184, p≤0.001). As a reflection of public health policy, the proportion of users consulting the tool for a positive contact without symptoms in children 6-12 years increased from 4% (1415/32 215) to 6% (636/9872) after the FOPH loosened testing criteria in this age group, χ²=69, p≤0.001. Adherence to the recommendation was generally high (84% (1131/1352)) but differed by the type of recommendation: 89% (344/385) for 'stay at home and observe', 75% (232/310) for 'school attendance'.

CONCLUSIONS

Usage of www.coronabambini.ch was generally high in areas where it was developed and promoted. Certain patterns in epidemiology and adherence to public health policy could be depicted but selection bias was difficult to measure showing the potential and challenges of digital decision support as public health tools.

Telephone Referral to a Paediatric Emergency Department: Why Do Parents Not Show Up?

Medical call centres can evaluate and refer patients to an emergency department (ED), a physician or provide guidance for self-care. Our aim was (1) to determine parental adherence to an ED orientation after being referred by the nurses of a call centre, (2) to observe how adherence varies according to children's characteristics and (3) to assess parents' reasons for non-adherence. This was a prospective cohort study set in the Lausanne agglomeration, Switzerland. From 1 February to 5 March 2022, paediatric calls (<16 years old) with an ED orientation were selected. Life-threatening emergencies were excluded. Parental adherence was then verified in the ED. All parents were contacted by telephone to respond to a questionnaire regarding their call. Parental adherence to the ED orientation was 75%. Adherence decreased significantly with increasing distance between the place the call originated and the ED. The child's age, sex and health complaints within calls had no effect on adherence. The three major reasons for non-adherence to telephone referral were: improvement in the child's condition (50.7%), parents' decision to go elsewhere (18.3%) and an appointment with a paediatrician (15.5%). Our results offer new perspectives to optimise the telephone assessment of paediatric patients and decrease barriers to adherence.

Analyse de la satisfaction des usagers du Samu 47 (Lot-et-Garonne) sur leur prise en charge dans le cadre de l’aide médicale urgente (AMU)

Objectif : Évaluer la satisfaction des usagers du Samu 47 à la suite de leur appel dans le cadre de l’aide médicale urgente.

Matériel et méthodes : Étude de cohorte observationnelle, monocentrique, prospective, menée entre le 25 août et le 13 septembre 2020 par un même opérateur, à partir d’un questionnaire téléphonique. Le critère de jugement principal était le niveau de satisfaction générale des requérants après leur appel. Les critères secondaires étaient le ressenti du délai de décroché ARM (assistant de régulation médicale) et médical, le niveau de satisfaction de la prise en charge ARM et médicale, le ressenti du délai d’arrivée des effecteurs envoyés, le niveau de satisfaction de leur prise en charge, la mise en application du conseil formulé par le médecin régulateur et la suggestion d’axes d’amélioration.

Résultats : Parmi les 596 requérants inclus, 419 (70 %) étaient « très satisfaits », 132 (22 %) « assez satisfaits », 25 (4 %) « peu satisfaits » et 20 (3 %) « pas du tout satisfaits ». Les analyses univariées montraient que cela était lié à l’entretien avec l’ARM et le médecin régulateur, à la prise en charge des secours, à certaines attentes, à la suite donnée à l’appel, au délai ressenti d’arrivée des secours et au délai ressenti de décroché. L’analyse multivariée révélait que les éléments liés à l’insatisfaction étaient l’attente « faire venir les secours » (RC : 5,71, IC 95 % : 2,56–13,01), le fait de recevoir un conseil à l’issue de l’appel (RC : 9,28, IC 95 % : 4,15–21,96) et le délai ressenti de décroché de l’appel jugé « long » (RC : 3,64, IC 95 % : 1,06–10,75).

Conclusion : Les usagers sont globalement satisfaits à la suite de leur appel au Samu 47.