Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19
Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19
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DOI：
10.1093/jamia/ocaa051
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发表时间：
2020-06-01
影响因子：
6.4
通讯作者：
Gonzales, Ralph
中科院分区：
文献类型：
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作者：
Judson, Timothy J.;Odisho, Anobel Y.;Gonzales, Ralph
目标：在大型学术卫生系统中快速部署面向患者的数字化自我分类和自我调度工具，以应对 COVID-19 大流行。材料和方法：我们创建了一个基于患者门户的 COVID-19 自我分类和自我调度工具，并将其提供给大型学术卫生系统加州大学旧金山分校健康中心的所有初级保健患者。无症状患者被询问接触史，然后被提供相关信息。有症状的患者被分为 4 类中的一类（急诊、紧急、非紧急或自我护理），然后通过直接安排或电话热线联系适当级别的护理。结果：这种自我分类和自我安排工具的设计和实施在不到 2 周的时间内。在使用的前 16 天里，950 名不同的患者完成了 1129 次。在已完成的疗程中，315 次 (28%) 是由无症状患者完成的，814 次 (72%) 是由有症状患者完成的。有症状的患者分类处理如下：急诊 193 例（24%）、紧急 193 例（24%）、非紧急 99 例（12%）、自我护理 329 例（40%）。检测紧急护理的敏感性为 87.5%（95% CI 61.7-98.5%）。讨论：这种自我分类和自我安排工具已被患者广泛使用，并正在迅速扩展到其他人群和卫生系统。该工具建议采取高灵敏度的紧急护理，并减少病情不太严重的患者的分诊时间。数据表明，它还可以防止不必要的分诊消息、电话和亲自就诊。结论：集成到电子健康记录系统中的患者自我分诊工具有可能大大提高分诊效率并防止在 COVID-19 大流行期间不必要的就诊。
Objective: To rapidly deploy a digital patient-facing self-triage and self-scheduling tool in a large academic health system to address the COVID-19 pandemic.Materials and Methods: We created a patient portal-based COVID-19 self-triage and self-scheduling tool and made it available to all primary care patients at the University of California, San Francisco Health, a large academic health system. Asymptomatic patients were asked about exposure history and were then provided relevant information. Symptomatic patients were triaged into 1 of 4 categories-emergent, urgent, nonurgent, or self-care-and then connected with the appropriate level of care via direct scheduling or telephone hotline.Results: This self-triage and self-scheduling tool was designed and implemented in under 2 weeks. During the first 16 days of use, it was completed 1129 times by 950 unique patients. Of completed sessions, 315 (28%) were by asymptomatic patients, and 814 (72%) were by symptomatic patients. Symptomatic patient triage dispositions were as follows: 193 emergent (24%), 193 urgent (24%), 99 nonurgent (12%), 329 self-care (40%). Sensitivity for detecting emergency-level care was 87.5% (95% CI 61.7-98.5%).Discussion: This self-triage and self-scheduling tool has been widely used by patients and is being rapidly expanded to other populations and health systems. The tool has recommended emergency-level care with high sensitivity, and decreased triage time for patients with less severe illness. The data suggests it also prevents unnecessary triage messages, phone calls, and in-person visits.Conclusion: Patient self-triage tools integrated into electronic health record systems have the potential to greatly improve triage efficiency and prevent unnecessary visits during the COVID-19 pandemic.