Expediting Emergency Throughput: Kiosk-assisted Care and Telephone Treatment Protocols

Abstract

showing that a novel use of kiosk-assisted managementof women with uncomplicated cystitis can lead to areduction in emergency department (ED) length of stay.Better still, their sizable time savings was accomplishedwithout compromise to patient safety or satisfaction. Theauthors are to be commended for introducing to emer-gency medicine an assessment tool that may well helpaccelerate patient throughput, a welcome improvementin these days of increasing ED congestion and crowding.Published telephone treatment protocols for cystitisprovided the framework for the investigators’ eligibilitycriteria. And this makes sense.Low-risk ambulatory med-ical conditions that are diagnosed principally by historywithout dependence on physical examination and labora-tory analysis—that is, the conditions that health mainte-nance organization call center nurses treat over thephone—are the very ones that lend themselves to kiosk-assisted care. The interactive ED kiosk and the speciallytrained call center nurse provide a similar kind of patientassessment. Both guide the symptomatic patient througha structured, step-by-step interview to ascertain eligibil-ity for expedited management. Both rely on the strengthof their exclusion criteria to weed out patients with over-lapping symptoms but different diagnoses (e.g., vaginitis)as well as those with more complicated versions of uri-nary tract infection (UTI; e.g., early pyelonephritis). Boththen transfer their assessment to a prescribing physicianwho, if in agreement with the plan for expedited care, canselect the most appropriate treatment.It is understandable that a groundbreaking study likethis would err on the side of cautious safety by adopt-ing more conservative inclusion criteria. But now thattheir proof-of-concept is established, the authors couldexpand the breadth of their eligibility net. Considerthose over 64 years of age, who in this study were noteven referred for kiosk care.In 2010 our call center nurses and physicians treatedover the telephone 54,226 women with presumed cysti-tis, 6,452 (11.9%) of whom were at least 65 years old.