The use of a self-check-in kiosk for early patient identification and queuing in the emergency department

Correspondence to: Dr. Zuhair Alsharafi, Department of Emergency Services, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, C753, Toronto, ON M4N 3M5 ; Email: [email protected]

CLINICIAN'S CAPSULE

What is known about the topic?

Emergency department (ED) wait-times before triage are not well captured and can represent a significant period of time.

What did this study ask?

Can a self-check-in kiosk be used by ambulatory patients to check into triage and decrease identification time?

What did this study find?

Self-check-in kiosks can be implemented effectively in the ED to improve patient identification time and queue patients for triage.

Why does this study matter to clinicians?

Local implementation of similar self-check-in kiosks could improve staff and patient satisfaction while improving departmental flow and patient experience.

INTRODUCTION

Prolonged wait-times in the emergency department (ED) increase mortality and hospital admission,¹ decrease productivity,² and increase patient complaints.³ Although the triage process is largely standardized,⁴ the method in which patients are identified on arrival and queued for triage is variable and ED arrival time is often captured.⁵ The typical first-come-first-serve triage approach does not account for patient acuity when determining triage order. Interestingly, delays to triage are rarely reported or included in wait-times and often exceed the Canadian Triage and Acuity Scale (CTAS) recommended time to physician initial assessment.⁴

We identified three concerns with our triage identification system. Firstly, it does not capture the number of patients waiting for triage, placing patients at risk of being unidentified for prolonged periods. Secondly, not queuing patients based on acuity may create delays in the management of time-sensitive conditions. Finally, it may cause confusion and anxiety for patients and result in unnecessary interruptions for triage staff.

Self-service kiosks are one strategy to improve ED operations⁶ and have been used effectively to distribute discharge instructions,⁷ screen patients,⁸ and enter basic medical history.⁹ We believe that introducing kiosks in ED waiting rooms can provide a solution to the triage identification gap. The goal of this study was to provide proof-of-concept that ED patients can use a self-check-in kiosk upon arrival and to compare time-to-first-identification with our current triage system.

METHODS

Study design, setting, and population

The prospective randomized trial took place at the ED of a tertiary...