TY - JOUR
T1 - Implementing remote triage in large health systems
T2 - A qualitative evidence synthesis
AU - Lewinski, Allison A.
AU - Rushton, Sharron
AU - Van Voorhees, Elizabeth
AU - Boggan, Joel C.
AU - Whited, John D.
AU - Shoup, John P.
AU - Tabriz, Amir A.
AU - Adam, Soheir
AU - Fulton, Jessica
AU - Gordon, Adelaide M.
AU - Ear, Belinda
AU - Williams, John W.
AU - Goldstein, Karen M.
AU - Van Noord, Megan G.
AU - Gierisch, Jennifer M.
N1 - Funding Information:
The authors thank Jennifer MacDonald, MD, for nominating the topic and providing input on project scope and methodology; Becky Yano, PhD, MSPH; Peter Koboli, MD, MS; and Danielle Rose, PhD, MPH, for input on project scope and methodological approaches; Eric Monson, PhD, for data visualization assistance; Soohyun Hwang, MPH, and Avishek Nagi, MS, for project assistance; and Liz Wing, MA, and Donnalee Frega, PhD for editorial assistance. This study was supported by the VA Evidence Synthesis Program (ESP 09‐010) and the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (CIN 13‐410) at the Durham VA Health Care System. Dr. Goldstein is supported by VA HSR&D CDA award #13‐263. Dr. Van Voorhees is supported by VA Rehabilitation Research & Development CDA (1K2RX001298). Dr. Whited is supported by VA HSR&D Awards SDR 16‐192 and 19‐006. Dr. Lewinski is supported by a VA OAA HSR&D PhD Fellowship TPH 21‐000. Dr. Rushton receives funding from HRSA Primary Care Training and Enhancement Program (TOBHP29992), which is not related to this study.
Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2021/2
Y1 - 2021/2
N2 - Remote triage (RT) allows interprofessional teams (e.g., nurses and physicians) to assess patients and make clinical decisions remotely. RT use has developed widespread interest due to the COVID-19 pandemic, and has future potential to address the needs of a rapidly aging population, improve access to care, facilitate interprofessional team care, and ensure appropriate use of resources. However, despite rapid and increasing interest in implementation of RT, there is little research concerning practices for successful implementation. We conducted a systematic review and qualitative evidence synthesis of practices that impact the implementation of RT for adults seeking clinical care advice. We searched MEDLINE®, EMBASE, and CINAHL from inception through July 2018. We included 32 studies in this review. Our review identified four themes impacting the implementation of RT: characteristics of staff who use RT, influence of RT on staff, considerations in selecting RT tools, and environmental and contextual factors impacting RT. The findings of our systemic review underscore the need for a careful consideration of (a) organizational and stakeholder buy-in before launch, (b) physical and psychological workplace environment, (c) staff training and ongoing support, and (d) optimal metrics to assess the effectiveness and efficiency of implementation. Our findings indicate that preimplementation planning, as well as evaluating RT by collecting data during and after implementation, is essential to ensuring successful implementation and continued adoption of RT in a health care system.
AB - Remote triage (RT) allows interprofessional teams (e.g., nurses and physicians) to assess patients and make clinical decisions remotely. RT use has developed widespread interest due to the COVID-19 pandemic, and has future potential to address the needs of a rapidly aging population, improve access to care, facilitate interprofessional team care, and ensure appropriate use of resources. However, despite rapid and increasing interest in implementation of RT, there is little research concerning practices for successful implementation. We conducted a systematic review and qualitative evidence synthesis of practices that impact the implementation of RT for adults seeking clinical care advice. We searched MEDLINE®, EMBASE, and CINAHL from inception through July 2018. We included 32 studies in this review. Our review identified four themes impacting the implementation of RT: characteristics of staff who use RT, influence of RT on staff, considerations in selecting RT tools, and environmental and contextual factors impacting RT. The findings of our systemic review underscore the need for a careful consideration of (a) organizational and stakeholder buy-in before launch, (b) physical and psychological workplace environment, (c) staff training and ongoing support, and (d) optimal metrics to assess the effectiveness and efficiency of implementation. Our findings indicate that preimplementation planning, as well as evaluating RT by collecting data during and after implementation, is essential to ensuring successful implementation and continued adoption of RT in a health care system.
KW - delivery of healthcare
KW - implementation science
KW - qualitative research
KW - systematic review
KW - telemedicine
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UR - http://www.scopus.com/inward/citedby.url?scp=85099898376&partnerID=8YFLogxK
U2 - 10.1002/nur.22093
DO - 10.1002/nur.22093
M3 - Article
C2 - 33319411
AN - SCOPUS:85099898376
VL - 44
SP - 138
EP - 154
JO - Research in Nursing and Health
JF - Research in Nursing and Health
SN - 0160-6891
IS - 1
ER -