Emergency Department TriaGe Kiosk Instiallation

Current Problem

  • Lengthy triage processes and wait times are a contributing factor in decreased patient satisfaction in emergency departments
  • Lengthy triage processes have been shown to hinder flow of patient care, and overall length of stay
  • 4% of patients that check in leave without ever being seen, and this is twice as high at the state average of 2% (Hospital Compare, 2016).

Knapman and Bonner (2009), suggest a variety of factors that can help improve input to ultimately expedite triage, some of which being initiating patient care while still in the waiting room, and diverting non acute ambulance patients to the waiting room rather than immediately placing them in a patient room. Saint Raphael’s Emergency Department is already conducting these recommendations, and still falling short.

Current Process

  • When a patient enters the waiting room they are greeted by a secretary who takes their identifying information and checks the patient in, and prints a wrist band
  • When multiple arrive around the same time a backflow of patients is created
  • When a patient additionally comes in that does not speak English this completely halts the process
  • Many times this leads to disgruntled patients and family members standing and waiting by the door

Propossed Solution

  • The introduction of 3 kiosk machines into the waiting room would allow patients to check in themselves
  • This would decrease backflow of patients waiting to check in and allow input of patients to become more efficient
  • In other emergency departments that had instituted this change an increase in both patient and staff satisfaction has been seen (Hay, 2007)
  • The kiosk can be programed to have multiple languages decreasing the language barrier problem
  • In a trial in California, greater satisfaction, improved accuracy, and faster triage times with introduction of bilingual kiosks upon check in (Sinha, Khor, Amresh, Drachman, & Frechette, 2014).
  • The time is takes to use the machine is less than the current process, and patients can even scan a government issues ID such as a license of passport to expedite the process

Cost

  • The cost of installation and training of 3 kiosks has been noted to the $50,000 (Hay, 2007)
  • After installation of the kiosks decreasing secretary hours during the day when there are already greeters and or volunteers in place would aid in recovering cost of kiosks, and over time the department would have money

Key Stake Holders

  • Nurses
  • Techs
  • secretaries
  • administration
  • patients

In conclusion, the introduction of a ED kiosk system to check patients in would aid in increasing the efficiency of triage, more accurate triage decisions, increased satisfaction with both staff and patients, and overall financial savings.

References

Ackerman, S. L., Tebb, K., Stein, J. C., Frazee, B. W., Hendey, G. W., Schmidt, L. A., & Gonzales, R. (2012). Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments. Social Science & Medicine, 75(12), 2378-2385. doi:10.1016/j.socscimed.2012.09.013

Chan, T., Killeen, J., Kelly, D., & Guss, D. (2005). Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen. Annals Of Emergency Medicine, 46(6), 491-497

Hay. (2007). Sign-in kiosks shorten waiting room lines: technology allows quicker ID of seriously ill patients. ED Management, 19(12), 137-138.

Hospital Compare. (2016). Retrieved October 21, 2016, from https://www.medicare.gov/hospitalcompare/profile.html#profTab=2&ID=070022&loc=N EW HAVEN, CT&lat=41.3081527&lng=-72.9281577&name=yale&Distn=0.6

Knapman, M., & Bonner, A. (2010). Overcrowding in medium-volume emergency departments: effects of aged patients in emergency departments on wait times for non-emergent triage- level patients. International Journal Of Nursing Practice, 16(3), 310-317. doi:10.1111/j.1440-172X.2010.01846.x

Lowe, C., & Cummin, D. (2010). The use of kiosk technology in general practice. Journal Of Telemedicine & Telecare, 16(4), 201-203. doi:10.1258/jtt.2010.004011

Sinha, M., Khor, K., Amresh, A., Drachman, D., & Frechette, A. (2014). The use of a kiosk- model bilingual self-triage system in the pediatric emergency department. Pediatric Emergency Care, 30(1), 63-68. doi:10.1097/PEC.0000000000000037

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Thayer Clark
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