Department of Emergency Medicine, University of California, San Francisco, USA.
Acad Emerg Med. 2011 Oct;18(10):1053-9. doi: 10.1111/j.1553-2712.2011.01167.x.
The objective was to assess the efficiency and safety of an interactive computer kiosk module for the management of uncomplicated urinary tract infections (UTI) in emergency departments (EDs).
This was a prospective unblinded randomized trial. Women age 18 to 64 years seeking care for suspected UTI in three urban EDs were referred to a computer kiosk after triage. The kiosk evaluated women for uncomplicated UTI (based on patient report of at least one irritable voiding symptom within 7 days and absence of complicating features), and eligible patients were randomized to expedited management or usual ED care. Expedited management consisted of a brief clinician encounter to confirm computer kiosk responses and selection of one of four standard antibiotic regimens. Study outcomes included urine culture results, duration of ED visit, time to illness resolution, return visits, and satisfaction with care.
Seventeen percent (n = 103) of 624 participants with suspected UTI fulfilled uncomplicated criteria and were randomized. Sixty-nine percent of these women had a positive urine culture. Compared with the control group, the computer-expedited management group had lower median visit duration (89 minutes, interquartile range [IQR] = 65 to 150 minutes vs. 146 minutes, IQR = 105 to 216 minutes) for a decrease of 57 minutes (95% confidence interval [CI] = 27 to 87, p = 0.004). They had similar time to illness resolution, number of return visits, and satisfaction with care.
An interactive computer kiosk accurately, efficiently, and safely expedited the management of women with uncomplicated UTI in a busy, urban ED. Expanding the use of this technology to other conditions could help to improve ED patient flow.
评估用于管理急诊科（ED）简单泌尿道感染（UTI）的交互式计算机亭模块的效率和安全性。
这是一项前瞻性、非盲法、随机试验。在三个城市的 ED 中，分诊后将年龄在 18 至 64 岁之间因疑似 UTI 就诊的女性患者转诊至计算机亭。该亭根据患者在 7 天内至少有一次烦躁性排尿症状和无复杂特征的报告评估女性是否患有简单 UTI，符合条件的患者随机分配到快速管理或常规 ED 护理。快速管理包括与临床医生进行简短的接触，以确认计算机亭的回复，并选择四种标准抗生素方案之一。研究结果包括尿液培养结果、ED 就诊时间、疾病缓解时间、复诊和对护理的满意度。
在 624 名疑似 UTI 的患者中，17%（n=103）符合简单标准并被随机分配。这些女性中 69%的尿液培养呈阳性。与对照组相比，计算机快速管理组的中位就诊时间更短（89 分钟，四分位间距[IQR]=65 至 150 分钟与 146 分钟，IQR=105 至 216 分钟），减少了 57 分钟（95%置信区间[CI]=27 至 87，p=0.004）。两组的疾病缓解时间、复诊次数和对护理的满意度相似。
交互式计算机亭可准确、高效、安全地加速繁忙的城市 ED 中简单 UTI 女性的管理。将这项技术的应用扩展到其他疾病可能有助于改善 ED 患者的流程。
