Digital triage in Västmanland
Triage as a first medical compass
“Triagen skapar bättre prioritering, bättre patientupplevelse och högre tillgänglighet”
In Region Västmanland, 1177 Direkt is used as a support to prioritize and direct patients correctly and increase accessibility in healthcare. Through digital triage, healthcare staff get an early picture of the patient’s needs, which makes it possible to act faster, work more systematically, and use resources better. The service has evolved from an initial effort during the pandemic into a central digital entrance to healthcare. Today, the chat is an established part of operations, where residents can get support, guidance, and assessment, as well as help moving further into care.
For Pia Stark, unit manager for 1177 by phone and chat, the development is not just about a new channel, but about a new way of working. Today the way of working is clearly structured: the majority of cases move on to the resident’s primary care center, while those assessed as more urgent in the triage are directed to 1177’s own operations for a first quick assessment.
Triage provides a first medical compass
For Pia, one of the biggest differences between phone and digital entrance is precisely the ability to get an initial picture of the case before contact begins.
“On the phone we have no triage. You might have five calls in the queue and you don’t know which one is actually most urgent. It might be call number three that’s about serious chest pain and really should be handled immediately. You don’t know that. That person just has to wait until their turn comes.”
In the chat, triage works as a first aid for prioritization.
– The triage gives us an indication of what the patient is seeking help for and how urgent it is. If you get three or four chats in at the same time, you can quickly see which one needs to be handled first. You never have that option on the phone. There, everything goes in the order the patients called in.
That doesn’t mean the triage replaces the nurse’s assessment. On the contrary, Pia is careful to describe it as support, not an answer key.
– It’s not the truth. It’s a rough picture of how the patient has answered the questions. That’s why we always ask a first question: “Can you describe, in your own words, the symptoms you have right now?” That gives us additional information about how urgent the case actually is.
This is where the value of triage becomes clear: it helps healthcare staff sort, prioritize, and work more precisely, while the professional assessment always remains decisive.
A value for the patient: not having to start over
Another important dimension is the patient experience. When the triage works well, the patient doesn’t need to repeat the same information over and over again.
In Västmanland, 1177 works actively with consent, so that primary care centers can access the previous chat, including summaries and any images.
“If the patient gives consent, the primary care center can read our previous chat. Then the patient doesn’t need to repeat themselves. That’s really important for the patient experience, because it’s a comment you often hear: that you have to say the same thing over and over.“
For Pia, this isn’t just about convenience, but also about using the information that already exists to create a better care chain.
– Our goal is to move away from patients needing to repeat themselves. If the primary care center has access to the chat, the images, and our summary, there’s already a foundation to build on.
This is also where triage takes on a systemic function. It becomes not just a support in the individual case, but part of building a more coherent flow of information between different parts of healthcare.
A more mature tool – and more mature users
Pia also describes how both the tool and residents have evolved over time. In the beginning, the answers in the triage could be contradictory or hard to interpret. Today she sees a clear difference.
– Patients have gotten better at understanding the triage flow, and I also feel the triage has become clearer. In the beginning there could sometimes be loops, and similar questions would come up several times. I don’t experience that in the same way anymore.
She particularly highlights that it has become easier to trust the auto-anamnesis generated by the triage.
– I used to be more skeptical of the auto-anamnesis. Now it’s more that you can trust it. Not blindly, but it provides much better support than before.
She also highlights the value of the free-text field, where residents can add information that isn’t fully captured by the question flow.
– The free text is valuable. Something the patient wasn’t quite sure how to fit into the triage can come through there, but it still gives us important information.
At the same time, she emphasizes that staff must be alert to the risk of forming a preconceived opinion.
– It’s important not to get stuck in the power words have over thought. Just because it says “strep throat” or “urinary tract symptoms” doesn’t mean I can lock myself into that. I still have to ask my questions and rule out other causes.
For the organization: better direction and higher capacity
For the organization as a whole, the digital entrance has also created new opportunities. When Region Västmanland moved from national collaboration to more regional management, the effects became clearer.
– What we see today is that if there’s a long queue on the phone, more people choose the chat. We have a button option for the chat within the phone system, and we see more people using it when the wait time gets longer.
According to Pia, the organization today handles roughly the same number of residents by phone as before, but also around 18,000 residents per year in the chat.
“Skillnaden är att vi besvarar fler samtal och har högre tillgänglighet. Vi ligger nästan uppe på 90 procent besvarade samtal. Chatten har för oss inneburit att vi har förflyttat invånare från telefon till en digital ingång.”
So it’s not just a new channel, but also a way to relieve the phone system and increase accessibility overall. And within the chat work itself, there’s also a clear efficiency gain. Here, triage becomes an important enabler: without the initial structure and prioritization, it would be considerably harder to work safely with several parallel cases.
“Normally, a nurse has between five and seven chats running at the same time. It depends on how quickly the resident responds and how complex the case is. But that means you can help several people at once in a way that isn’t possible on the phone.“
Healthcare that meets residents where they are
Pia returns several times to the point that digital entrances aren’t just an internal efficiency matter, but a question of meeting residents’ expectations.
– Many younger people are used to communicating in writing. They text each other all the time. We in healthcare need to meet that, because in a way it’s the future.
When the region rolled out the chat broadly, volumes increased quickly, from around 1,500–1,800 chats per month to around 7,500–8,000.
– There’s a need, otherwise it wouldn’t look like that. Different groups of residents choose different channels. Some want to call and talk to someone. Others want to write. So we need to be able to offer different ways in.
That reasoning also applies to the new initiative on video assessment calls, which has recently been introduced on weekday evenings. Pia sees particularly great benefit here when it comes to children.
– It’s difficult to describe symptoms on another person. If I, as a nurse, can see the child at the same time, I get a completely different ability to assess general condition, breathing, skin color, and tone. It has been incredibly valuable to have that channel.
She also sees video as a way to create reassurance, especially in situations where the patient or guardian is worried but may not need physical care.
A tool that must be understood to be used correctly
An important point in the interview is that digital triage isn’t just about introducing a tool. It’s about building knowledge within the organization.
Pia herself has engaged deeply with how the triage works, which flows direct patients to different priority levels, and how the results should be interpreted.
– You have to understand how the system works to be able to work with it. If you don’t understand how the triage engine works and thinks, it becomes difficult to analyze the result and know how to handle it.
That also applies to staff, even though they don’t need the same deep system knowledge.
“Staff need to understand enough to be able to evaluate what they receive and flag when something seems off. If someone wonders why a chat ended up with us as priority 1, we need to be able to go back and understand why. This is also where the traceability of digital tools becomes a strength. When something feels wrong, it can be followed up, analyzed, and improved.“
Advice for others who want to succeed with digital triage
In closing, Pia points to a few keys for other organizations that want to get more value from digital entrances and triage:
– Talk a lot about the digital channels and who they’re for. It’s the residents who are asking for these services, and we in healthcare need to adapt.
– Don’t be afraid of the digital tools. They don’t give you the truth, but they give you a map. You still have to use your patient safety mindset.
– And learn how the system works. You can’t work against the system. You have to understand it to be able to use it correctly.
For Pia, it’s precisely in that combination that the real value emerges: a digital tool that provides structure and support, a profession that makes the medical assessment, and an organization willing to develop its ways of working based on how residents actually want to seek care.