kiosks shorten waiting room lines

Technology allows quicker ID of seriously ill patients

The installation of three self-service computer stations, or kiosks, in the ED at Parkland Memorial Hospital in Dallas has not only reduced long lines in the waiting area, but also enabled the staff to more quickly identify the more urgent cases.

"We used to have huge lines to check in," recalls Jennifer Sharpe, RN, the ED director, who says her department sees more than 139,000 patients a year. "At times of high volume, we would have maybe three or four nurses doing the check-in process, and that takes about five or six minutes per patient."

Being in an urban area, and with patients having access to mass transit, as many as 50 patients can arrive at once, Sharpe explains. "These big boluses caused problems: No. 1, the patients had to stand up, and even if there were 20 people in line, there could be a critical case that was not evident — like a patient with chest pain who did not tell you," she says. "You can look at them and guess, but if the nurses are all tied up doing assessments, you might not see through to the end of the line."

Now, says Sharpe, the patients come in and sit down at the kiosk. They type in their basic demographic information and then answer questions about their condition and history. "The computer has pictures of body parts they can identify, and then they are asked if they have pain, if they have diabetes, and so on," Sharpe explains. (The kiosks, manufactured by Galvanon, of Maitland, FL, actually were suggested by a patient. See story below.)

Listening to patient pays off for ED

A suggestion from an observant patient started the ED staff at Parkland Memorial Hospital in Dallas on a journey that eventually led to the installation of three sign-in kiosks. It's a move, they say, that has eased the wait for patients and helped the staff more quickly identify more serious cases.

"We had a patient who came in and saw [the long waiting lines] in the ED and felt we could be more efficient," recalls Jennifer Sharpe, RN, the ED director. "He was in the IT field, and he helped us get grant funding from a private individual for some sort of self-service check-in."

Members of the ED staff started their research, and they found to their dismay that "no one was doing anything like this in the ED," says Sharpe. They did, however, find a company named Galvanon in Maitland, FL, that had a primary focus on outpatient clinics. "I don't even know if they had done urgent care centers before," she says.

Galvanon won the bid to develop their system using the grant, which was actually given to University of Texas (UT) Southwestern (with which Parkland is affiliated). The cost for installing the three kiosks was $50,000.

Testing the system

The kiosks were formally installed in March 2007, but a small pilot test was conducted about 2½ years ago, recalls Jennifer Hay, RN, the ED's unit manager.

"I got together with our computer guy, made up the system, and went out to patients with a laptop to see if they could navigate it," she recalls. "We did it for one day and got feedback from lots of patients."

Through that feedback, as well as the early use of the kiosks, the system was adjusted for ease of use. "At first, the patients couldn't navigate it," says Sharpe. "They have an average third-grade [reading] level, and they do not use computers frequently enough." Some directions, for things as basic as entering your first and last name, were simplified, and a touch keyboard is provided on the screen. Terms such as "diabetes" were changed to "blood sugar." In addition, a tech is there to help patients who have difficulty with the system.

"The patients see the kiosks as soon as they walk in the front door," says Hay. The technician who helps them is also a greeter, she says. "They welcome them to the ED and show them to the kiosk, explaining it is for self check-in and that the medical staff will be with them shortly."

The ED nurses have screens in every room, so once the patients have entered their information, they have data on every patient in the waiting room.

Many benefits seen

The kiosks have provided several benefits, although improved flow was not necessarily one of them, says Sharpe. "They were never really designed to help efficiency," she says. "It was to provide [seating] comfort for the patients, speed up the waiting process, and rapidly identify people who were critically ill."

For the first month, they talked to patients who were here before and after the hospital obtained kiosks, says Hay. "Most of them were very happy with them," she says. The primary reason they gave for their satisfaction was that they felt their information was in the system and that somebody knew they were there, Hay adds.

"This has been mainly patient-driven," she says. "They can sit down, and they have privacy because they don't have to talk to someone in an open space." The kiosk is similar to a small voting booth, Hay says. "No one can see what you type in," she says. "Before, the whole triage area was one open space."

Although they didn't set out to improve throughput, they hoped that would happen, Sharpe says. "It's absolutely true we are seeing the sicker patients more quickly," she says. "I can't capture much data on that because we did not having anything before, but now it takes less than five minutes to get a [seriously] sick patient to a nurse and immediately intervene."


For more information on using computer kiosks in your ED waiting room, contact:

  • Jennifer Hay, RN, ED Unit Manager, or Jennifer Sharpe, RN, ED Director, Parkland Health & Hospital System, 5201 Harry Hines Blvd., Dallas, TX 75235. Phone: (214) 590-8735. Phone: (407) 667-0669. Fax: (407) 667-8774.