A three-layer framework for pre-hospital triage to reduce non-urgent emergency use in Germany

Background

Emergency departments in Germany and across Europe continue to experience inappropriate utilisation by non-urgent cases despite established primary care pathways. This reflects persistent gaps in patient navigation and decision-making before care-seeking. AI-supported triage has emerged as a potential upstream intervention but lacks structured integration into public health systems.

Objectives

To develop a system-level framework for integrating AI-supported pre-hospital triage into healthcare access pathways to reduce non-urgent emergency department utilisation.

Methods

A policy and systems analysis was conducted, combining evidence synthesis with structured mapping of patient care pathways within the German health system. A three-layer integration framework was developed: (1) access (digital entry-point triage), (2) routing (linkage to primary care and telehealth), and (3) system feedback (data integration into planning and resource allocation). The framework was assessed across feasibility, safety, and equity.

Results

The framework identifies leverage points to redirect patients before emergency department entry. Key success factors include interoperability, clear escalation protocols, and risk stratification safeguards, including thresholds for high-risk cases. A central trade-off is identified: while AI-supported triage may improve efficiency, it risks reinforcing inequities and misclassification if digital exclusion and governance challenges are not addressed. Hybrid models combining digital tools with human support are critical.

Conclusions

AI-supported pre-hospital triage represents a feasible systems-level intervention to improve care navigation and reduce unnecessary emergency use. Embedding such tools within existing structures—while addressing equity, safety, and governance—will determine their impact and transferability across European health systems.

Key messages

• A structured three-layer approach can improve patient navigation and reduce system inefficiencies by shifting decision-making before emergency care use.

• Without safeguards, AI triage may misclassify high-risk patients and exclude digitally disadvantaged groups, potentially worsening inequities in access to care.