By Dr. Kevin Maloy, April 2015
A kiosk that streamlines patients with uncomplicated Urinary Tract Infections (UTIs) in an Emergency Department (ED); that seems like a no-brainer. Just develop an algorithm, install the kiosk, get nurses to direct patients to it, and let the magic happen.
Every healthcare entrepreneurs should ask themselves two questions after reading this article:
#1 Am I assuming that all patient populations are the same? The kiosks Ackerman studied were somewhat successfully deployed in an urgent care setting prior to deployment in the ED. Most people would think that if an algorithm worked in the urgent care patient population, it would work in the ED. Not the case. Patients self select themselves to the ED because their symptoms are more severe, and tend to be sicker. This increase severity made many patients fall out of the kiosk algorithm and make the patients ineligible for kiosk-assisted care.
This had downstream effects on referrals to the kiosk. Since many patients were unable to be processed by the kiosk, staff thought it useless to tell patients about it. The kiosk was seen as more of a “detour” to care, than care itself. Great quote:
“The kiosk is supposed to be easy and reduce wait time, like at the airport,” said one nurse at Valley Hospital, “but everyone we sent to the kiosk was ineligible!” Eligibility was referred to as a “winning lottery ticket” a rare and seemingly random event that for many nurses was not worth the effort required to get patients to the kiosk.
Interestingly, when the algorithm was revised to increase the number of eligible patients, referrals did not improve. It was often forgot since as few as one or two patients a day actually came to the ED primarily for UTI symptoms.
#2 Is my product really disrupting the status quo? On the surface, kiosks in the ED seem to be disruptive. When I began reading the article, I thought the patient would walk up the kiosk, answer some questions, and get a prescription like going to an ATM. After all, many primary doctors have been doing something similar to this over the phone for many years.
However, the kiosk did not handle the whole encounter. Instead, it fast tracked eligible patients to the provider and “spoon fed” the paperwork to the provider to complete. They still had to have a medical screening exam as required by EMTALA. Furthermore, the paperwork for UTIs without the kiosk was straightforward anyway. Great Quote:
[T]reating a simple UTI “isn’t that difficult and doesn’t take that much time, so spending extra time to get people to the kiosk isn’t worth it.”