Tele-triage has the potential to reduce the number of ED visits and associated costs in patients with chest pain, but though it has been shown to be safe and cost-effective in pediatric studies, little is known about its use in adults or the way it affects cost, quality of care, and the patient's experience. A change in protocol at an integrated health care delivery system's call center provided researchers with the opportunity to compare outcomes and costs when calls from patients with chest pain were routed to RNs or physicians. With the new protocol, calls from patients age 36 or older complaining of chest pain were forwarded directly to emergency physicians instead of to nurses assisted by physicians, as had been done in the past.

The researchers assessed 22,630 calls that were directed equally to physicians and nurses. Physician-directed calls were shorter than nurse-directed calls. Both groups infrequently referred callers to the ED, though physicians did so less often than nurses. Instead, both nurses and physicians advised most callers to make an appointment or, in some cases, sent a message directly to the caller's primary care provider. Rates of adherence to the tele-triage provider's recommendation were high for both groups, although slightly higher for physician-directed calls. Hospital admission rates were similar for callers who had spoken to physicians and those who had spoken to nurses, and seven- and 30-day mortality rates were low for both groups. In their limited analysis of cost, the researchers estimated that physician-directed calls, as compared with those managed by nurses, resulted in a $2 million cost savings during the one-year study period.

The authors note that tele-triage for urgent and emergent complaints may be best suited to integrated settings in which comprehensive electronic health records are available, noting that the results of this study may not be fully generalizable to other settings.

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