Does a novel digital self-triage and scheduling pathway reduce wait times for low-acuity emergency department visits in a Canadian community hospital? A prospective cohort study.

OBJECTIVES

The objectives were to evaluate if a novel self-triaging and self-scheduling emergency department (ED) service, the Minor Ailment Patient Pathway (MAPP), can safely reduce ED wait times for low-acuity patients presenting with either cold and influenza or musculoskeletal ailments.

DESIGN

Prospective cohort study including all consecutive ED patients from 1 June 2023 to 31 March 2024. Outcomes for MAPP patients were compared with contemporaneous, matched ED patients who followed the usual care (UC) ED intake and evaluation process.

SETTING

Single acute care hospital, Royal Victoria Regional Health Centre, located in Ontario, Canada.

PARTICIPANTS

Of 73 132 ED visits during the study period, 2766 (3.8%) used the MAPP. Low-acuity patients, defined by the Canadian Triage and Acuity Scale (CTAS) 3 or 4-5, comprised 59.4% and 34.1%, respectively, of all ED patients.

RESULTS

Most MAPP visits were for cold and influenza symptoms (63.6%) or musculoskeletal ailments (18.4%). Compared with CTAS-matched UC patients, MAPP users had a shorter mean length of stay (LOS) and faster mean physician initial assessment (PIA) time (adjusted LOS: -0.44 hours, 95% CI -0.84 to -0.05 and adjusted PIA: -1.22 hours, 95% CI -1.42 to -1.01). 7-day return visits occurred in 3.2% of MAPP patients compared with 4.4% of UC patients (p=0.002), with fewer admissions on return (1.8% vs 13.2%; p<0.001). Over 95% of surveyed patients reported being satisfied or very satisfied with the MAPP process and their overall ED experience.

CONCLUSIONS

MAPP was associated with shorter LOS, faster PIA, lower rates of return visits and hospital admissions, and high patient satisfaction, all suggestive of a safe, efficient and patient-centred ED service. Despite these benefits, MAPP was underused with only 9.3% of all cold and influenza and musculoskeletal ED patients self-triaging and self-scheduling an ED MAPP visit during this cohort period.