# Follow-Up of Low-Acuity Patients After Redirection From a Swiss Emergency Department Using an Electronic Triage Application: Protocol for a Single-Center Prospective Cohort Study

## TL;DR

This study tests if redirecting non-urgent patients from an emergency department using an electronic system is safe and reduces ED workload.

## Contribution

A novel electronic triage system is evaluated for safely redirecting low-acuity patients to alternative care settings.

## Key findings

- The electronic system's safety and efficiency in redirecting patients will be assessed through unexpected healthcare returns.
- Patient satisfaction and healthcare use will be tracked over six months to evaluate long-term outcomes.
- Positive results could establish a reproducible strategy to reduce ED patient volume.

## Abstract

Emergency department (ED) overcrowding threatens health care systems worldwide. This poses risks to patient safety, lowers quality of care, and reduces patient satisfaction. Patient input, defined as the caseload of patients presenting to the ED, is one of the factors contributing to overcrowding. Redirecting patients with nonurgent complaints to external health care services could help alleviate ED workload.

The primary objective of this study is to investigate the safety and efficiency of redirection of low-acuity patients using an electronic clinical decision support system. As a secondary and exploratory aim, we will assess the impact of this intervention on subsequent health care use, patient satisfaction, and health literacy over a 6-month follow-up period.

A single-center observational study with 2 consecutive cohorts of low-acuity patients presenting to the ED will be conducted. The first cohort will be triaged and offered redirection according to current practice. In the second cohort, after triage, low-acuity patients will be evaluated by an electronic clinical support system to determine eligibility for redirection. If eligible for redirection, an appointment at a nearby clinic will be arranged through the system. The primary end point is any unexpected returns to health care services within 48 hours of triage. Secondary end points are patient satisfaction as well as the number of unexpected consultations and the evolution of health literacy during a 6-month follow-up period.

This study is funded by an internal grant from Hôpital Fribourgeois. Recruitment began on June 20, 2025, with a total of 35 patients enrolled as of August 2025. Data analysis will begin after the recruitment and 6-month follow-up of 300 to 420 patients are completed, which is expected to occur in November 2026. We hope to publish results in December 2026.

We expect the redirection process of low-acuity patients to other health care facilities using an electronic clinical support system to be safe and efficient. If results are positive, application of this reproducible strategy could reduce the number of patients treated in EDs and provide alternative health care pathways for low-acuity patients.