BACKGROUND: In the recent decades, the use of computerized decision support software (CDSS) -integrated telephone triage (TT) has become an important tool for managing rising healthcare demands and overcrowding in the emergency department . Though these services have generally been shown to be effective, large gaps in the literature exist with regards to the overall quality of these systems . In the current systematic review, we aim to document the consistency of decisions that are generated in CDSS-integrated TT . Furthermore, we also seek to map those factors in the literature that have been identified to have an impact on the consistency of generated triage decisions .
METHODS: As part of the TRANS-SENIOR international training and research network, a systematic review of the literature was conducted in November 2019 . PubMed, Web of Science, CENTRAL, and the CINAHL database were searched . Quantitative articles including a CDSS component and addressing consistency of triage decisions and/or factors associated with triage decisions were eligible for inclusion in the current review . Studies exploring the use of other types of digital support systems for triage (i.e . web chat, video conferencing) were excluded . Quality appraisal of included studies were performed independently by two authors using the Methodological Index for Non-Randomized Studies .
RESULTS: From a total of 1551 records that were identified, 39 full-texts were assessed for eligibility and seven studies were included in the review . All of the studies (n = 7) identified as part of our search were observational and were based on nurse-led telephone triage . Scientific efforts investigating our first aim was very limited . In total, two articles were found to investigate the consistency of decisions that are generated in CDSS-integrated TT . Research efforts were targeted largely towards the second aim of our study-all of the included articles reported factors related to the operator- (n = 6), patient- (n = 1), and/or CDSS-integrated (n = 2) characteristics to have an influence on the consistency of CDSS-integrated TT decisions .
CONCLUSION: To date, some efforts have been made to better understand how the use of CDSS-integrated TT systems may vary across settings . In general, however, the evidence-base surrounding this field of literature is largely inconclusive . Further evaluations must be prompted to better understand this area of research . PROTOCOL REGISTRATION: The protocol for this study is registered in the PROSPERO database (registration number: CRD42020146323).
Index: CDSS, Computerized decision support software, Systematic review, Telephone triage, Unplanned care