Remote triage and virtual urgent care services: A qualitative assessment of factors that impact triage decisions and outcomes

Abstract

Background

Remote nurse triage services are increasingly delivered through call centers to manage demand for urgent and unscheduled care. These encounters typically rely on decision-support tools, but safe and efficient outcomes also depend on how nurses interpret patient information and make decisions about the most appropriate level of care. Despite the growth of tele-triage, nurse decision-making in this context remains underexplored.

Objective

To examine factors shaping triage decisions and outcomes in the U.S. Department of Veterans Affairs’ (VA) national tele-triage and urgent care program.

Methods

We conducted semi-structured interviews with 39 participants, including triage nurses, nurse managers, and virtual urgent care providers, across six VA regions. Interviews explored decision-making processes, perceived challenges, and coordination between nurses and providers. Transcripts were coded and analyzed thematically.

Results

Four categories of factors influenced triage decisions: (1) technology—decision-support tools structured encounters but were limited by usability issues and risk-averse design; (2) professional training and judgment—nurses varied in critical thinking and remote assessment skills; (3) organizational priorities—policies emphasizing safety and liability restricted decision-making discretion; and (4) patient factors—preferences, beliefs, and situational constraints shaped acceptance of virtual care. Participants described tensions between efficiency and safety, and providers thought some Veterans’ symptoms were more appropriately treated through primary care, reflecting institutional pressures.

Conclusions

VA's tele-triage process is shaped by decision-support tools, nurse expertise, organizational priorities, and patient preferences. Algorithms provide structure, but effective triage depends on nurses’ ability to interpret recommendations in context. As call center-based tele-triage expands, ensuring technology supports rather than constrains clinician judgment will be essential for safe, efficient, and patient-centered care.