ED Kiosks Are Effective, but Some Nurses Question Value

TOPIC ALERT:

A study published last year in the journal Academic Emergency Medicine found that interactive computer kiosks accurately, efficiently and safely expedited the management of woman with uncomplicated urinary tract infections at busy, urban emergency departments. However, a follow-up report by the California HealthCare Foundation found that some triage nurses did not refer eligible patients to the kiosks because they believed the technology disrupted their workflow. CHCF publishes California Healthline.

Ralph Gonzales
As the lead researchers in these two studies, we would like to clarify what we see as the main results of our studies to prevent any misperceptions that we are inferring that nurses served as an obstacle to successful implementation of the kiosk program. We do not believe nurses are to blame for the failure of the kiosk program to become fully adopted in these EDs. In fact, quite the contrary. Ineligibility for expedited care (due to clinical criteria or randomization to the control group) created additional work for staff to re-insert women who returned to the front desk into the queue for regular care. Nurses’ feedback gave us critical insight into the reasons for this failure. We view the honest responses from nurses and physicians in our evaluation to be a valuable starting point for developing better implementation strategies for this promising technology, specifically the lessons we’ve learned are summarized on page 5 of the case study.
Sheila Proctor
I think and hope you included nurses in the development of this study, or in the refinement of having Kiosks. As described, they could be helpful, but if they interfered with flow and work process, there is some adjustment. As a nurse, I am offended by the description of the nurses perceptions of workflow and patient satisfaction. I think that if a nurse found that it impeded the workflow, then it did, period, and that needs to be listened to. Would you describe physician's perceptions in the same way and discount them in the same way? Patient satisfaction surveys are notoriously positive. Nurses, we need to speak up and have concrete ideas for solutions to these problems that we are faced with every day. We cannot disregard the technology, but how can we participate in making it work? Thank you.
Robert Siemer
The nurses's concerns suggest the need for adjustments (primarily in patient flow), not cancelation. It is telling that two EDs wanted to continue using the device.
Betty Hillman
The denigration of nurses' input is disturbing, at best. Being a nurse who has practiced in multiple arenas of care (ICU, CCU, PACU, ED, HHA, Hospice, etc), I can vouch for the fact that if nurses are saying it impacts their time, researchers and hospitals need to listen and act, rather than, one more time, overlooking the obvious impact to THE PATIENT--ie, impacted ED flow means poorer patient care.

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