Virtual Triage Practices in Emergency General Surgery Patients from Freestanding Emergency Departments: A 5-Year Analysis

Abstract

INTRODUCTION: Freestanding Emergency Departments (FSEDs) have risen in popularity, reducing emergency department (ED) wait time and demand at overburdened hospitals. Although there has been limited evaluation into FSED utility in psychiatric populations, there are no data evaluating virtual triage disposition in surgical populations without physical examination by surgical team. We report our experience virtually triaging emergency general surgery (EGS) patients from an affiliated FSED to discharge, Level I trauma center (TC) or community hospital (CH). METHODS: EGS patients presenting to FSED with surgical consultation between 2016 and 2021 were analyzed. Outcomes included length of stay (LOS), surgical intervention, and 30-day mortality and readmission. Undertriage and overtriage rate was calculated and defined as: (1) discharge undertriage: discharge home with 30-day ED visit/readmission; (2) transfer undertriage: admission to CH requiring transfer to TC; and (3) overtriage: admissions <24 hours without operation. RESULTS: Of 1,105 patients, 167 (15%) were discharged home, 303 (27%) were transferred to TC, and 635 (58%) transferred to CH. Patients admitted to TC were older with higher Charlson Comorbidity Index scores and higher acuity pathology, but CH had higher operative rate and laparoscopy with shorter length of stay, operating room time, 30-day readmission, and mortality. Transfer undertriage was 0.9% (n = 6) with 1 due to disease acuity. Discharge undertriage was 12% (n = 20) due to worsening or stable pathology. Overtriage was 5.5% (n = 52) with most having a partial small-bowel obstruction or ambiguous diagnostic imaging necessitating observation. CONCLUSION: Virtual EGS triage at FSED to disposition, without an in-person examination, demonstrated both low undertriage and overtriage rate, reflecting appropriate triage practices.