Self-Service Emergency Rooms

[shesulsa]

Newark Beth Israel Medical Center in New Jersey plans to install check-in kiosks in its ER within the next couple months.

“Patients don’t always know if their symptom is potentially bad or serious,” said Dr. Marc Borenstein, chairman and residency program director for the department of emergency medicine at Beth Israel.


Parkland’s administrators say patients have been spared the long check-in lines since the kiosks arrived. The hospital’s ER handles about 300 cases a day.


“It’s helping us find the people that we need to see right now,” said Jennifer Hay, unit manager for the ER department.


Patients spend about eight minutes at the kiosks, using touchscreens to enter their name, age, and other personal information. The computer shows the patient a list of ailments to choose from, like “pain” or “fever and/or chills” and a list of body parts to indicate where it hurts.

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I'm not sure how I feel about this. There are many ways in which it sounds very good, other ways that scare me.

I wonder about standardization of care in a non-standard situation ... such as high-risk childbirth, rapidly changing heart conditions, embolisms, stroke, etcetera.

Thoughts?

 

[exile]

What concerns me about this sort of thing is the fact that people often have difficulty giving accurate description of sensations, experiences, and so on. Even with descriptions of measurable events and situations, people's firsthand impressions and recollections are unreliable, as studies of eyewitness testimony and short-term memory have shown. But when it comes to their own bodies, people are likely to be way less precise and accurate (look at how difficult it is for people to agree on how to talk about how things taste, as vs. what they look like). So being guided in the preliminary screening by the self-reports, where the doctor isn't physically present to monitor the patient's actual condition, seems to me to be putting way too much of a burden on the patient's descriptive abilities.

 

[MBuzzy]

Who determines which cases are too severe for the kiosks? I see a lot of arguments arising due to some patients being able to skip the kiosks. Though that is a necessary part of this system. If I come in with a severed hand or a bleeding gunwound, I wouldn't be able to stand at a Kiosk for 8 minutes...but someone with not as severe symptoms will think that they are just as important.

 

[Drac]

What concerns me about this sort of thing is the fact that people often have difficulty giving accurate description of sensations, experiences, and so on

Well said Exile...I've responded to medical emergencies arriving prior to the Rescue Squad and those in distress who are concious and breathing cannot tell me where it hurts and why it hurts so if need be I can relay that info to the Squad crew..

 

[exile]

Well said Exile...I've responded to medical emergencies arriving prior to the Rescue Squad and those in distress who are concious and breathing cannot tell me where it hurts and why it hurts so if need be I can relay that info to the Squad crew..

Right, Drac—and if critical decisions are to be made on the basis of those self-reports, you have to wonder how many of them are going to lead to misassessments on the first past that then have to be corrected later on, losing maybe more time than the original self-service procedure `saved'?

I myself know, from personal experience, that often the thing that I'm focusing on (or even obsessing about ) is medically the more trivial part of the situation. It's true, someone who's in the ER because they lost an argument with a buzzsaw is going to have a pretty good idea of just why it hurts where it hurts; but I've been in the ER enough times—either on my own account or in connection with injury to a family member or friend—to see that people are in there with all sorts of serious but nonobvious complaints (sitting in an ER in Albuquerque last year when my son started vomiting in the middle of the night, and waiting for four or five hours before we got to see an MD, was quite a revelation in this respect!) And I'd bet the the medical AI program has yet to be written that can do an automated, even remotely accurate evaluation of the kind of data that will be collected in those kiosks.

 

[Drac]

And how many people that reach the ER suddenly feel so much better that they forgo treatment altogether..

 

[MA-Caver]

And how many people that reach the ER suddenly feel so much better that they forgo treatment altogether..

Probably quite a few considering how some people are just plain impatient. They go to the E.R. see the triage nurse and then wait half hour, an hour, 90 minutes ... then "aww the hell with this!" and go on out back home.

Another problem with the kiosk system I see is that as it was said that people don't know how to accurately diagnose their own symptoms.
Example: they have a severe stomach ache but don't know why. Their whole abdomen hurts and is tender to the touch, it's gotta be something they ate...right? Food poisoning maybe ... but man it hurts though. (possible acute appendicitis)

Their head hurts a little bit but they're there because they ate something and vomited violently short-time afterwards. Earlier in the day they received a severe blow to the head but it didn't know them out and they were dazed for a wee bit but doing okay now... but really worried about the vomiting thing so they focus on that, never mind the blow to the head, it didn't bleed so it's okay... (possible concussion).

People have various levels of pain tolerances. What's a simple ouch to me might be agonizing to you. So someone may have a problem that is usually associated with severe pain but they tolerate it fairly well.

Personal assessment of a medical problem I think isn't the way to go. Yes, they go and tell the triage what's bothering them and it's up to triage to give a quick review of the symptoms and vitals and catagorize them.

Main problem with E.R.s is not enough staff to help minimize the wait.
My dad when he fell and broken his L-5 vertebrae waited SIX hours before the doctor finally came and saw him. X-rays and CAT scans were taken about three to four hours into that six hour wait. IMO that is simply way too long.

 

[Drac]

Main problem with E.R.s is not enough staff to help minimize the wait.
My dad when he fell and broken his L-5 vertebrae waited SIX hours before the doctor finally came and saw him. X-rays and CAT scans were taken about three to four hours into that six hour wait. IMO that is simply way too long.

Yep..My pregnant step daughter was taken in with stomach pains and waited for 4 hrs..The triage nurse kept apologizing and I finally said out loud to "Quit apologizing and tell your bosses to hire some flipping ( not the f word I used) staff members..

 

[Jade Tigress]

I don't know what to say about this. I just saw the movie "Idiocracy", this premise is too frightening similar. Watch this hospital scene.

 

[theletch1]

How long after the kiosks go in before people start figuring out how to "work" the system? Don't feel like waiting? Well, just figure out which symptoms the machine will flag highest and punch those in regardless if they are actually part of your problem.

You've all brought up great points on the self eval side of things. I foresee alot of law suits in there future for patients dying in the waiting room because they had the burden of self diagnosis placed on themselves instead of a competent medical professional.

 

[Kacey]

In addition to all of the great ideas above... what about people who aren't literate in English, or who don't speak English? Will they even know what to do when they're confronted with a kiosk when they walk into the ER?

As other have said, I understand the reasoning behind the concept... but I'm really concerned about the execution of the concept.

 

[exile]

In addition to all of the great ideas above... what about people who aren't literate in English, or who don't speak English? Will they even know what to do when they're confronted with a kiosk when they walk into the ER?

The automated ER people will probably start with the assumption that English and Spanish are enough (the way our bank machines do here in Columbus). And then the scenario you're envisaging will arise: people from Somalia, or Thailand, or Haiti, some in probably really bad shape, now trying to figure out how to even tell the system that they can't talk to it... Instant Catch-22. Eventually, the setup will have to be upgraded so that the same instructions are available in 40 or 50 different languages (an improvement, but not foolproof by any means)... with little flag icons so people will know how to even get instructions on how to proceed further.... yikes...

It's true that under the current system you don't have translators around for 40 languages; but I've seen what happens: the reception person sees that the patient is in considerable distress and doesn't speak English, Spanish or some other more familiar non-English language, and somehow they manage to get someone out there who can function well enough to do a preliminary bit of triage to see where in line the patient should be. It works well and it's fast: if someone is turning blue, or seems to be going into a convulsions, they get whisked into a room for immediate treatment. Vital signs are a universal language....

Someone maybe needs to rethink the execution of the whole project from a number of different angles. I don't like the idea of automated ER procedures any more than I like the idea of automated phone-response setups in doctors', retail and especially government offices (we all have war stories to tell about those—you feel as though you might get a stroke from it; but what about in an ER, where someone may well actually be having one, no figure of speech involved?)

 

[MA-Caver]

The automated ER people will probably start with the assumption that English and Spanish are enough (the way our bank machines do here in Columbus). And then the scenario you're envisaging will arise: people from Somalia, or Thailand, or Haiti, some in probably really bad shape, now trying to figure out how to even tell the system that they can't talk to it... Instant Catch-22. Eventually, the setup will have to be upgraded so that the same instructions are available in 40 or 50 different languages (an improvement, but not foolproof by any means)... with little flag icons so people will know how to even get instructions on how to proceed further.... yikes...

It's true that under the current system you don't have translators around for 40 languages; but I've seen what happens: the reception person sees that the patient is in considerable distress and doesn't speak English, Spanish or some other more familiar non-English language, and somehow they manage to get someone out there who can function well enough to do a preliminary bit of triage to see where in line the patient should be. It works well and it's fast: if someone is turning blue, or seems to be going into a convulsions, they get whisked into a room for immediate treatment. Vital signs are a universal language....

Someone maybe needs to rethink the execution of the whole project from a number of different angles. I don't like the idea of automated ER procedures any more than I like the idea of automated phone-response setups in doctors', retail and especially government offices (we all have war stories to tell about those—you feel as though you might get a stroke from it; but what about in an ER, where someone may well actually be having one, no figure of speech involved?)

Same thing with hearing impaired folks. By law they're supposed to be provided an (ASL) interpreter. But if their condition is life threatening then time is wasted on getting one... unless (like some) the hospital has a staff member with the skills necessary... and if they're on duty.
Since my parents are both deaf and my father is also blind/deaf I have to be there if and when they go. Especially with my father as there are not too many interpreters who have the necessary skills to interpret to a deaf/blind individual.
Once I was shoo-ed away by staff members and I started to argue for a couple of words then instantly shut-up and said... "ok... YOU talk to him... "uhh, err, ahh, umm... could you come back in here sir?" (Oh NOW it's Sir!)
Granted a great many deaf individuals can read and figure stuff out by looking at it. But chances are they're going to bring someone with them (family member or close hearing friend) to help them out. Still, if they're on their own they may be in for a rough ride.

With computer technology as it is today and improving all the time, I don't see too much difficulty adding 10-20 mbs of additional info on to the present program to have a wide variety of languages available to non-engrish speaking people requiring assistance.

It's the concern that Letch1 expressed that I agree with that people will abuse the system just so to "cut-ahead in line."

 

[Gordon Nore]

Whatever money went into developing this technology and is being spent implementing it could be better spent on staff IMO. Notwithstanding people who overuse the ER, lots of folks there are scared to death, and I don't see how tapping a menu screen is going to alleviate anyone's anxiety.

Just a thought -- with all these people tapping these screens with their fingers, aren't we just passing more germs from hand to mouth, or am I being petty?