Improving the time-efficiency of initial mental health assessment (triaging) using an online assessment tool followed by a clinical interview via phone: A randomised controlled trial

Background: The need for time-efficient and accessible mental health assessment is a priority in the face of high and increasing demand and limited resources in the context of progressive increase over time in the percentage of adults experiencing high or very high levels of psychological distress. Although there is broader supportive evidence for using online assessment as a potential solution, there is relatively little evidence from randomised controlled trials. Objective: To investigate whether patient online self-reported clinical information can save clinician time in mental health assessment via phone. Methods: Patients referred by general practitioners via fax during business hours between February 2020 and June 2022 were randomly allocated to either the intervention (self-reporting of clinical information followed by clinician assessment) or control (assessment as usual). Time to complete assessment (call duration) was the outcome measure. Results: Out of 758 referrals assessed for eligibility, 377 (49.34%) entered the study and were randomised. Out of 184 allocated to the intervention arm, assessment was completed in 125, but only 81 were included in the analysis, mostly due to clinician error in completing assessment without using self-reported data, due to inexperience with the novel process. Of 193 referrals allocated to the control arm, only 135 completed assessment and were included in the analysis. Average assessment completion times in the control arm was 25.19 minutes (standard deviation (SD) of 11.5 minutes) and 20.76 minutes (SD 7.49 minutes) in the intervention arm respectively, with a mean difference of 4.43 minutes (17.59% time reduction). When a mixed effects linear model was used to adjust for potential seasonal effect and correlation of outcome within clinicians, a statistically significant reduction of 3.29 minutes ( P  = 0.016, 95% CI (5.85, 0.73)) was still demonstrated by using online assessment. Conclusion: Use of online self-report clinical assessment by patients can save time to complete subsequent clinician assessment. Greater time-saving can be expected with increased clinician familiarity with using online self-reported data. Trial registration (registered retrospectively) Registry: Australian and New Zealand Clinical Trial Registry (ACTRN). Registration number: anzctr.org.au ACTRN12624001293550. Date of registration: 24/10/2024.