Emergencies
Conditions
Keywords
Triage, Automated, Admitting, Pediatric ED
Brief summary
An audio-assisted self-triage kiosk in the Pediatric Emergency Department (ED) is expected to significantly reduce triage times, without any sacrifice of the quality of information that would be obtained by nurse-initiated triage.
Detailed description
With the rapid evolution of consumer based information technology patients have the opportunity to become collaborative partners in their care. In addition, by bridging information gaps and improving workflow efficiency, continuity of care is optimized and the potential risk for error is reduced. Triage time for kiosk self-triage and nurse-initiated triage will be compared in terms of 1) triage time; 2) accuracy of medical history obtained; and 3) patient satisfaction.
Interventions
OTHERNurse-initiated triage
Nurse-assisted triage for obtaining medical history and presenting problem(s)
OTHERSelf-triage kiosk
Audio-assisted self-triage kiosk for obtaining medical history and presenting problem(s)
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Valleywise Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
* Between 0 and 18 years of age * Registered in the Pediatric ED * Accompanied by parent/guardian 18 years or older * Version 3 Emergency Severity Index (ESI) of 3 to 5 * Parent or guardian able to communicate in English or Spanish
Exclusion criteria
* Deemed medically unstable * ESI score of 1 or 2 * Incarcerated or in juvenile detention * Parent/guardian unable to communicate in English or Spanish
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Triage Time | From beginning of triage to completion of triage. | The time it takes for the patient to be triaged, compared across the kiosk and nurse-initiated triage conditions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Accuracy of Medical History | Upon completion of triage. | To check for accuracy of medical history information, two RAs approached enrolled parents during the course of their ED visit in the individual patient examination rooms. The RAs conducted a brief face-to-face interview with parents and verified information from the nursing triage summary sheet (for non-kiosk users) and the printout of history sheet from the kiosk users, noting any discrepancies on a Discrepancy Rating Scale. All historical discrepancies were categorized into three groups: major discrepancy, minor discrepancy and no discrepancy. |
| Patient Satisfaction | Upon completion of triage. | Custom survey with 4 items capturing satisfaction with Understanding, Ease of Answering Questions, Respect for Privacy, and Overall Feelings. For each item, the lowest possible score was 1 and the highest possible score was 6. For Understanding, the lowest actual score was 2 and the highest actual score was 6. For Ease of Answering Questions, the lowest actual score was 2 and the highest actual score was 6. For Respect for Privacy the lowest actual score was 3 and the highest actual score was 6. For Overall Feelings, the lowest actual score was 3 and the highest actual score was 6. For the (unweighted) average of all 4 items, the lowest possible score was 1 and the highest possible score was 6. The lowest actual score was 3.5 and the highest actual score was 6.0. |
Countries
United States
Participant flow
Recruitment details
Patients were recruited from the Pediatric Emergency Department at Maricopa Integrated Health System between February 2012 and April 2012.
Participants by arm
| Arm | Count |
|---|---|
| Nurse-initiated Triage Nurse-initiated triage for obtaining medical history and presenting problem(s)
Nurse-initiated triage : Nurse-assisted triage for obtaining medical history and presenting problem(s) | 200 |
| Self-triage Kiosk Audio-assisted self-triage kiosk for obtaining medical history and presenting problem(s)
Self-triage kiosk : Audio-assisted self-triage kiosk for obtaining medical history and presenting problem(s) | 200 |
| Total | 400 |
Baseline characteristics
| Characteristic | Total | Nurse-initiated Triage | Self-triage Kiosk |
|---|---|---|---|
| Age, Categorical <=18 years | 400 Participants | 200 Participants | 200 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age Continuous | 6 years STANDARD_DEVIATION 5 | 6 years STANDARD_DEVIATION 6 | 6 years STANDARD_DEVIATION 5 |
| Region of Enrollment United States | 400 participants | 200 participants | 200 participants |
| Sex: Female, Male Female | 180 Participants | 89 Participants | 91 Participants |
| Sex: Female, Male Male | 220 Participants | 111 Participants | 109 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Triage Time
The time it takes for the patient to be triaged, compared across the kiosk and nurse-initiated triage conditions.
Time frame: From beginning of triage to completion of triage.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nurse-initiated Triage | Triage Time | 126.7 Seconds | Standard Deviation 62.6 |
| Self-triage Kiosk | Triage Time | 94.4 Seconds | Standard Deviation 38.6 |
p-value: <0.000595% CI: [22.1, 42.6]t-test, 2 sided
Secondary
Accuracy of Medical History
To check for accuracy of medical history information, two RAs approached enrolled parents during the course of their ED visit in the individual patient examination rooms. The RAs conducted a brief face-to-face interview with parents and verified information from the nursing triage summary sheet (for non-kiosk users) and the printout of history sheet from the kiosk users, noting any discrepancies on a Discrepancy Rating Scale. All historical discrepancies were categorized into three groups: major discrepancy, minor discrepancy and no discrepancy.
Time frame: Upon completion of triage.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nurse-initiated Triage | Accuracy of Medical History | 1.03 Inaccuracies | Standard Deviation 0.97 |
| Self-triage Kiosk | Accuracy of Medical History | 0.59 Inaccuracies | Standard Deviation 0.81 |
Secondary
Patient Satisfaction
Custom survey with 4 items capturing satisfaction with Understanding, Ease of Answering Questions, Respect for Privacy, and Overall Feelings. For each item, the lowest possible score was 1 and the highest possible score was 6. For Understanding, the lowest actual score was 2 and the highest actual score was 6. For Ease of Answering Questions, the lowest actual score was 2 and the highest actual score was 6. For Respect for Privacy the lowest actual score was 3 and the highest actual score was 6. For Overall Feelings, the lowest actual score was 3 and the highest actual score was 6. For the (unweighted) average of all 4 items, the lowest possible score was 1 and the highest possible score was 6. The lowest actual score was 3.5 and the highest actual score was 6.0.
Time frame: Upon completion of triage.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nurse-initiated Triage | Patient Satisfaction | 5.6 units on a scale | Standard Deviation 0.8 |
| Self-triage Kiosk | Patient Satisfaction | 5.7 units on a scale | Standard Deviation 0.7 |