How does triage by an electronic symptom checker match with triage by a nurse in primary care?

Tuomas Koskela, Ville Liu, Minna Kaila

Keywords: triage, symptom checker, eHealth

In Finland, Omaolo© electronic symptom checkers (ESCs) were developed to make triage for primary care patients. Based on analysis of the patient’s responses to a standard set of questions, the ESC classifies him/her as emergent, urgent, not urgent, or advices on self-care. At present, there are 16 ESCs in use, and integrated into primary care electronic services. The user (patient) answers questions about their symptoms on the Omaolo© website and gets triage guidance. The idea is to help the user to more adequately assess their condition, and to ease the professionals’ triage workload.
To our knowledge, ESCs have previously been studied only by using standardized patient vignettes.

Research questions:
How does triage by an ESC match with triage by a nurse? How safe is triage by ESC?

Patients were recruited in primary health care waiting rooms. They were there asked to use the ESC to triage themselves, and then taken to the nurse, who did the same without knowing the ESC guidance. After the triage decision, the nurse accessed the ESC guidance and commented on it if that case was a mismatch. The participating nurses were experienced in triage for at least two years. Data on 14 different ESCs were collected in ten primary health care centers in 2019-2020.

For preliminary results 700 cases were explored. In 55 % of cases, the triage was exactly same by nurse and symptom checker. Out of 189 cases classified as urgent by nurse, 25 were classified as not urgent or as self-care by ESC. We explored the cases in detail in which the patient safety was possibly threatened, but found no need to change the algorithm. The final results will be displayed in the congress.

The patient safety of the ESC triage was not threatened although the percentage of the matches was quite low.

Points for discussion:
When can you rely on symptom checker?