Welcome to the ED - Please Step Up to the...Kiosk???

Turtle: http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/060707dnmeterkiosk.37be576.html

Parkland's kiosks speed check-in

Parkland computer kiosks eliminate lines, frustrate some

08:02 AM CDT on Thursday, June 7, 2007

By KIM BREEN / The Dallas Morning News

After Vivian Beachum mistook anti-fungal solution for contact lens drops, her first conversation at Parkland Memorial Hospital's emergency room wasn't with a nurse.

A computer asked her where she hurt.

Instead of standing in line – sometimes for hours – just to explain their symptoms at one of the nation's busiest emergency rooms, Parkland patients now type their woes into a computer at one of three automated check-in kiosks. The idea is to keep sick folks from having to stand while waiting, and to more quickly reach patients who might not look sick but whose illness demands immediate attention.

"It was real efficient," said Ms. Beachum, who didn't have to wait in a long line or worry about eavesdroppers. "Nobody can hear."

While similar machines are popping up nationally to check in patients at medical clinics, Parkland officials said they believe they are among the first to have a system in a hospital emergency room. A donation through UT Southwestern Medical School paid for the $50,000 project.

The kiosks went up just two weeks ago, and kinks are still being worked out. Because of the people served at the public hospital – including a large indigent population – the technology can present challenges. The machines look and operate a lot like automated check-in kiosks at the airport.

"A lot of these folks don't use a computer at all," said Jamie Ensminger, a nurse in charge of the project. "They get really aggravated."

But Parkland personnel stand by to give directions and type in information for people who need help, and the hospital continues to adjust to make the system more user-friendly, he said.

Parkland's emergency services department sees about 300 patients a day, and 115,000 to 120,000 a year, said unit manager Jennifer Hay.

Before the system went in, patients could stand for hours, "like a ride at Six Flags," Mr. Ensminger said. Nurses constantly monitored the condition of people waiting – and pulled from the line people who were in obvious need of immediate help.

But some potentially life-threatening problems – like chest pain or stroke symptoms – aren't always easy to see, and some patients are too shy to complain.

At the kiosks, patients type in their name, birth date and gender before being led to myriad ailments from which they choose their chief complaint. Patients can choose English or Spanish.

If the first laundry list of problems doesn't fit – allergic reaction, homicidal thoughts, shortness of breath, and so on – patients can point on the screen to a specific body part that hurts. Certain ailments, combined with information like the person's age, are immediately flagged. Monitors in the nurses' station keep a tally of who is waiting, and blinking dots cue them to people who should be seen right away – like an older person with chest pains, for example.

"It just gives me another set of eyes," said nurse Brandon Gardner. "In theory, it's great with an ER as busy as we are."

But, he said, it also has its shortfalls. Patients who are illiterate or not computer savvy need lots of help.

Ms. Beachum, who described her age as "50-plus," said she liked the system. "I am computer illiterate," she said. Even so, "It is easy, self-explanatory."

James Jones, 68, also was a fan. "I did need help," he said, but once he got that and entered information, he was immediately called up to a nurse. "I usually have to wait hours," he said.

But even patients familiar with computers had some frustrations.

Tallan Askew, who was doubled over with stomach pain as he waited for care this week, said his fingers were too big for the screen, so he kept making the wrong selections. A staff member had to help him through the system, he said.

"I'd rather have a pen and paper," said Mr. Askew, who is 20.

Patients with less serious illnesses still must wait for care during busy times. But the long lines have been eliminated, Mr. Ensminger said.

"Our first goal is met," he said. "People are able to sit down."

While patients could always lie, picking more serious conditions when in fact they only stubbed a toe in order to get called first, hospital officials said that practice could occur even without the kiosks.

Parkland is already using the new data to analyze how long people have to wait for care. A patient's record previously didn't start until he or she made it through the first line. Now, that record starts almost immediately.

Ms. Hay said that if the kiosks are a success – and she thinks they will be – she expects they'll pop up in other hospitals.

"It could catch on really easily," she said.

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