Department of Medicine, University of California San Francisco, San Francisco, California.
Clinical Innovation Center, University of California San Francisco, San Francisco, California.
J Am Med Inform Assoc. 2020 Jun 1;27(6):860-866. doi: 10.1093/jamia/ocaa051.
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.
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.
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%).
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.
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.
在大型学术医疗系统中快速部署数字患者自助分诊和自我调度工具，以应对 COVID-19 大流行。
我们创建了一个基于患者门户的 COVID-19 自我分诊和自我调度工具，并将其提供给加利福尼亚大学旧金山分校健康中心的所有初级保健患者，这是一个大型学术医疗系统。对无症状患者询问其接触史，然后为其提供相关信息。有症状的患者被分诊为 4 个类别之一：紧急、紧急、非紧急或自我护理，然后通过直接预约或电话热线与适当级别的护理联系。
该自我分诊和自我调度工具在不到 2 周的时间内完成设计和实施。在使用的前 16 天中，有 950 位不同的患者完成了 1129 次。在已完成的就诊中，有 315 次（28%）是无症状患者，814 次（72%）是有症状患者。有症状患者的分诊处置如下：193 例紧急（24%），193 例紧急（24%），99 例非紧急（12%），329 例自我护理（40%）。检测到紧急护理的敏感性为 87.5%（95%CI 61.7-98.5%）。
该自我分诊和自我调度工具已被患者广泛使用，并正在迅速扩展到其他人群和医疗系统。该工具对紧急级别护理的建议具有较高的敏感性，并减少了轻症患者的分诊时间。数据表明，它还可以防止不必要的分诊信息、电话和当面访问。
整合到电子健康记录系统中的患者自助分诊工具有可能极大地提高分诊效率，并在 COVID-19 大流行期间防止不必要的就诊。
