JMIR Publications

ABSTRACT

Background:

In overcrowding emergency departments (EDs), triage nurses spend too much time on paperwork related to patient registration, which impedes timely identification. With self-service technologies, triage nurses could focus on high-order tasks. Kiosks have barriers to direct patient flow spatially, socially, and clinically.

Objective:

To use mobile technologies to improve pre-triage flow in EDs.

Methods:

The proposed system welcomed each ambulatory arrival using quick response codes, which were posted just outside the walk-in entrance. Patients or their proxies could scan to complete self-registration. Upon submission, the result was saved locally on smartphones instead of uploading over the internet. As code readers were popularly used in hospitals, triage nurses could automatically read these data in and save time for recollection. The study was conducted at a busy metropolitan ED, with an annual census of 306,000. Both kiosks and smartphones were evaluated randomly while being used to moderate pre-triage patient flow.

Results:

Overall, 2,180 patients registered on kiosks and 2,695 arrivals checked in using their smartphones. By comparing kiosks to smartphones, there was a statistically significant difference in referring (49.72% [1,084] vs. 8.79% [237]; difference, 40.93%; 95% CI, 38.58%-43.29%; p < 0.001) and throughput (68.22% [53.95] vs. 86.46% [66.75]; difference, 18.17%; 95% CI, 5.38%-30.96%; p < 0.001). There was no statistically difference in completion time (1.3±0.51 minutes vs. 1.41±0.26 minutes; p = 0.33). For patient ratings, there was a statistically significant difference in usability satisfaction (4.41±1.47 vs. 6.67±0.7; p < 0.001), time satisfaction (4.45±1.37 vs. 6.75±0.61; p < 0.001), and support satisfaction (4.86±1.93 vs. 6.63±1.09; p < 0.001). For nurse ratings, the difference was also statistically significant (10% vs. 100%; p < 0.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps.

Conclusions:

This study suggests patient-carried smartphones as a tool for ED self-registration. With increased usability and the tailored queueing model, it poses to minimize pre-triage waiting for ED patients.