The digital transformation of healthcare has introduced new ways of conducting triage, particularly in primary care settings. Nurses in Sweden have increasingly adopted text-based digital triage, replacing traditional telephone consultations. This shift has altered their professional practices, influencing their ability to assess patients, communicate effectively and manage workflow. Their experiences reveal both challenges and advantages, shaping the future of digital healthcare implementation. Understanding these experiences is crucial for refining digital triage systems and ensuring they effectively support both nurses and patients.
Using Digital Tools for Patient Assessment
With text-based triage, nurses rely on written communication and digital forms rather than spoken conversations. This transition presents a fundamental challenge: the loss of auditory cues, or the "clinical ear," which nurses previously used to assess patients’ conditions based on tone, breathing patterns and emotional state. Without these audio cues, understanding symptom severity becomes more complex, requiring nurses to develop alternative strategies to compensate for the lack of verbal interaction. However, digital triage also introduces advantages, such as the ability to assess visual information when patients submit images of skin conditions, rashes or wounds. This capability enhances diagnostic accuracy in certain cases, providing an additional tool in the triage process. Nurses have noted that such visual evidence can aid in making informed decisions, particularly when assessing conditions with clear external manifestations. Despite these benefits, challenges remain in cases where symptoms are less visible and require further verbal clarification.
Challenges in Digital Communication
Nurses report difficulties in conveying empathy and clinical judgment through written communication. While text-based messaging allows for asynchronous interactions, it can feel impersonal and lacks the nuance of voice-based interactions. Some nurses struggle with expressing care and reassurance through text, particularly when delivering unwelcome news or denying patient requests. The absence of verbal cues makes it harder to gauge patients’ emotional states, potentially leading to misinterpretations or dissatisfaction. Furthermore, patients’ varied literacy levels and communication styles impact the clarity of exchanges, requiring nurses to invest additional effort in formulating precise questions and responses. The reliance on text-based systems, therefore, shifts the burden of effective communication onto both healthcare professionals and patients. Nurses must carefully construct their messages to avoid ambiguity and ensure patients fully understand the guidance provided. This additional layer of complexity can extend response times and create inefficiencies in patient interactions.
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Time Management and Workflow Adjustments
The shift to digital triage has also altered the use of time within primary care settings. While telephone triage allows for real-time decision-making, digital triage often involves delays due to the asynchronous nature of messaging. Nurses may receive responses from patients hours or days later, extending the resolution time for cases that could have been handled swiftly via phone. This creates inefficiencies in workflow and increases uncertainty, particularly in urgent cases where prompt intervention is required. Delays in communication can be particularly problematic in scenarios requiring immediate assessment, necessitating additional follow-ups or even reverting to phone calls to clarify concerns. On the other hand, digital triage can provide more flexibility, allowing nurses to manage their workload more strategically and revisit cases as needed. For patients, this system can improve access to care, enabling them to engage at their convenience without waiting in telephone queues. It also allows nurses to organise their work with greater autonomy, prioritising urgent cases while handling non-urgent queries over an extended timeframe. This approach can enhance efficiency but also requires careful monitoring to prevent prolonged delays in patient responses and decision-making.
The introduction of text-based digital triage has significantly transformed the role of nurses in primary healthcare. While it enhances accessibility and provides new tools for assessment, it also introduces barriers related to communication quality, workflow efficiency and patient safety. Nurses must adapt to a changing professional landscape, developing new competencies in digital communication and assessment. The transition requires a careful balance between efficiency and ensuring high-quality patient interactions. Future improvements in digital triage systems should focus on integrating multimodal approaches, such as video consultations, to mitigate current limitations and ensure high standards of care. Additionally, providing nurses with training in digital communication and structured frameworks for text-based interactions may enhance the effectiveness of digital triage, improving both nurse workflow and patient outcomes.
Source: BMC Nursing
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