Emergency Department (ED) overcrowding is a growing national problem and has been shown to adversely impact routine ED workflow. With the advancement in medical information technology, some ambulatory care centers and urgent care facilities have started using consumer based "kiosks" for patient self-registration where a patient is able to walk in and self-register prior to being seen by a healthcare provider. This process can be coupled with a system in which patients document their brief medical history through a series of standard triage questions. Such a document can be reviewed and self-attested by the patient. The hypothesis for this study is that use of an audio assisted self-triage "kiosk" in the pediatric ED will reduce triage time. Parents will be able to input their child's presenting complaints and basic medical history in English or Spanish using a touch screen. This information is expected to be comparable to that obtained during a routine nurse-initiated triage and will lead to greater parental/user satisfaction. The objective of this study is to compare time to obtain standard triage medical history using audio assisted self-triage kiosk and compare it to the time required to obtain same history in a routine nurse initiated triage and enter it on a patient's electronic medical record (EMR). Further, we will compare the accuracy of information between the two systems, assess parental/user satisfaction with the system and also do a cognitive task analysis. This study will be conducted in the pediatric ED of a tertiary care inner city teaching hospital, parents of patients enrolled in the study will be randomized either to a routine nurse-initiated triage arm or to the "intervention" arm where they will enter their child's presenting complaints and basic medical history using an audio assisted touch screen "kiosk" with both English and Spanish features. If it is determined that use of a "kiosk" model self-triage system is time efficient, information provided is comparable to that of a standard nurse triage, and the system is user friendly, in the future this information could be automatically integrated into the patient's EMR. Also for English as a Second Language (ESL) patient, automated translation features in commonly used languages could promptly translate patient's triage history into a valid document reducing triage times and improving patient workflow in a busy ED. In addition to its role in streamlining "front end operations" in an ED, the system could find similar use in any ambulatory care setting such as physician offices, ambulatory surgery centers, and urgent care centers.

Public Health Relevance

Emergency department (ED) overcrowding is a growing national problem and has been shown to adversely impact routine ED workflow. We propose to study the use of a dual-language (English and Spanish) kiosk model self-triage system in the Pediatric ED where parents are able to self input their child's presenting complaints and basic medical history. We hypothesize that this self triage system will lead to shorter triage time, comparable accuracy of patient medical history to that obtained during routine nurse initiated triage thereby improving ED workflow which is a key factor impacting ED overcrowding, and that the self-triage kiosk system will lead to greater parental satisfaction.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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Health Systems Research (HSR)
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Hagan, Michael
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Maricopa Integrated Health System
United States
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Sinha, Madhumita; Khor, Kai-Ning; Amresh, Ashish et al. (2014) The use of a kiosk-model bilingual self-triage system in the pediatric emergency department. Pediatr Emerg Care 30:63-8