Some EDs are nearly as chaotic as airports but not the one at Newark Beth Israel Medical Center (NBIMC), thanks to nurses reengineering and self-check touch screens similar to those used by airlines.
Without kiosks whether at airports or EDs customers would have to wait to register on a first-come, first-served basis, regardless of urgency. With kiosks, incoming patients no longer stand in slow-moving queues, and those who need speed are quickly identified, escorted or boarded on a gurney, and whisked to their destinations.
Under our old system, we saw everyone in the waiting room, but didnt know who the patients were if they came with other people, and we had no idea of their complaints, especially if they were stoic, says Debra Apostol, RN, CEN, assistant nurse manager of the ED at NBIMC, an affiliate of the Saint Barnabas Health Care System. We have glass windows so we can see who are at the kiosks as theyre signing in and make decisions about where they should go.
The former typical 12-minute wait to sign in on paper has been eliminated by six self-check touch-screens in the ED waiting room. On arrival, walk-in patients are greeted by an ED technician. Unless they appear to need immediate care, the technician escorts them to a kiosk.
Three are attached to the wall, each with its own booth and privacy screen. Three other portable, wireless tablet PCs are available, primarily for people
Patients take an average of 45 seconds to answer up to 15 yes/no on-screen questions, written at a sixth-grade level. Their complaints, ages, and symptoms appear instantly on nurses computer screens.
Some answers trigger warning indicators, such as blinking red lights when patients acknowledge suicidal thoughts.
At least two or three triage nurses are looking at their screens to see who is signing in, and three charge nurses are also checking them between patient care, says Amy Doran, RN, MS, APN-C, assistant vice president. We can immediately pull out the diabetic person with chest pains, or the 45-year-old woman with stroke-like symptoms.
Better for everyone
The efficiency benefits everyone and has quantifiable patient care benefits. We halved the time a person with chest pain waits to get an EKG, says Doran. Some conditions are exacerbated by standing, so now when theyre triaged, we get a better picture of patients conditions, without their having the stress and aggravation of waiting on their feet for 15 minutes, says Apostol.
Patient and visitor violence and frustration decreased significantly. When lines were so long that people were almost standing outside the door, there were quarrels about who was first or who cut in, says Doran. Every outburst is disturbing for patients and staff, and when taking care of those problems, you arent providing other care.
Nurses benefit, too. They learn the system in approximately 15 minutes and appreciate its efficiency, says Apostol. Overall, theyre not as stressed, angry, frustrated, or disappointed. Theyre happier when they leave because theyve gotten patients to where they need to be.
Since every administrator has screen access, they and ED managers can monitor length of wait, acuity, and patient prioritization, and can determine where to redirect patients within ED areas, Doran says. I can call from the nursing office, ask what they need, and deploy additional staff from less critical hospital areas, she says.
Patients are comfortable using kiosks, and some are more apt to disclose symptoms, such as psychiatric problems. Apostol says that the improved registration speed, privacy, and service has measurably increased customer satisfaction and lowered considerably the number of patients who leave without being seen.
Although retaining more paying customers helps to offset the one-time $100,000 cost, its a bonus benefit. Installing the system was the right thing to do for our patients, says Doran. Were here to take care of the community.
Editors note: For more information, contact Debra Apostol at (973) 926-7240 or [email protected]