The term Telehealth has come to stand for both the industry-at-large, as well as pre-hospital or telephone triage — an earlier form of remote, virtual care — in place of a a face to face visit or ED visit. Even before the pandemic, telehealth already had many facets and subsets – including home telemonitoring and management of chronically ill patient groups.

When the COVID epidemic hit, contagion was a risk for face to face visits for patient and clinician alike. Literally overnight, remote encounters became a new form of healthcare.

However, Telehealth now requires research on safe outcomes, and validating safe methods, training, processes and tools. Some experts believe that remote and even on-site triage may be at increased risk for system error (Wachter, 2017). Research points to pitfalls including remote nature of the work, subspecialty underdevelopment, incomplete systems and inadequate, poorly designed computerized decision support software (CDSS) (Wheeler, 2015).

Telephone triage is described as a form of symptom risk assessment and triage by phone by clinicians. Essentially, it involves making decisions under conditions or uncertainty and urgency (Patel, 1995). Face-to-face triage can be challenging, and remote clinical decision-making (when one cannot see the patient or even by televisit) is more difficult. Clinicians must gather adequate, relevant information in order to estimate symptom urgency.

Telephone triage predates telehealth by 50+ years. Still an informal subspecialty, clinicians perform this task Informally and formally, in ambulatory care settings ranging from physician offices, clinics, student health centers, disease management and ambulatory surgery, to Urgent Care, emergency department (ED) and Labor and Delivery settings, triage is ubiquitous.

Soon, the broad, high-tech field and industry of telehealth (video visits, biotelemetry, patient wearables) will subsume telephone triage – a technologically limited field based on outdated technology.

Both telehealth and telephone triage are remote encounters, but differ in several ways. Although evolving into possibly emergent encounters, telehealth is typically a pre-scheduled encounter about a non-urgent matter. Whereas, telephone triage calls are typically about acute, time-sensitive symptoms. Calls are brief (2-15 minutes), unscheduled, initiated by patients seeking clinicians’ help to decide symptom acuity. Patient want clinicians to evaluate and instruct them about when,where and why they need to be seen - in the ED, Urgent care, Office or simply Home Treatment.

The next generation of telephone triage will require a wide range of high-tech features (video, biotelemetry, Predictive analytics, AI and patient wearables). Advanced technology will transform remote encounters into data driven virtual visits.

What Lies Ahead?

Currently, telephone triage rightfully qualifies as a form of “pre-hospital care“ — and requires serious attention. As an emerging nursing subspecialty and initial entry point into the continuum of care, telephone triage requires “guard rails” — a system. Traditionally, a system is composed of structure and process. Typically, systems have standard components - clinical training, standards, qualified, experienced staff, documentation and Guidelines — EMR and CDSS.

Software developers can enhance patient safety (Gawande) by developing systems to reduce recurrent error. The foundation — the Duty of Due Care — requires both clinicians and employers to “do what a reasonable, prudent clinician or employer would do under the same or similar conditions”.

IIf nurse triage is ever to be regarded and embraced as an established professional clinical subspecialty, it must meaningfully demonstrate its allegiance to healthcare traditions and values. Those values include accessibility to care, serving broad patient populations and patient safety.

If any CDSS is to be accepted, trusted and quickly adapted --by nurses, physicians, and healthcare administrators, then developers must meaningfully demonstrate that both the system and decision support tool are valid and reliable. Safety is at the heart of remote triage – uncertain and urgent.