Safety and Efficacy of Digital Check-in and Triage Kiosks in Emergency Departments: Systematic Review.

BACKGROUND

Emergency departments (EDs) globally face unprecedented pressures due to aging populations, multimorbidity, and staff shortages. In response, health systems are adopting technological solutions such as digital kiosks to reduce wait times, improve patient flow, and alleviate overcrowding. These tools can automate patient check-in and assist with triage, helping to reduce variability in assessments and identify individuals with urgent needs sooner. However, it remains unclear whether the potential time-saving benefits of these innovations translate into improved patient outcomes and safety.

OBJECTIVE

This systematic review aims to summarize the safety and efficacy impacts of digital check-in and triage kiosks compared with traditional nurse-led triage methods in EDs.

METHODS

Comprehensive searches were conducted in MEDLINE, EMBASE, and Web of Science. A narrative synthesis was carried out to evaluate the impact on patient safety (eg, agreement rate, accuracy, sensitivity, and specificity) and efficacy (eg, operational efficiency and patient flow). The quality of the studies was assessed using the National Heart, Lung, and Blood Institute quality assessment tools.

RESULTS

A total of 5 studies, comprising 47,778 patients and 310,249 ED visits, were included. Out of these 5 studies, 3 focused on self-check-in kiosks, one on self-triage kiosks, and another on technology combining both. Among 5 studies, 2 evaluated safety, reporting high sensitivity for predicting high-acuity outcomes (up to 88.5%) and low under-triage rates (8.0%-10.1%) but poor agreement with nurse-assigned triage scores (27.0%-30.7%). Specificity for low-acuity cases was variable, with one study reporting as low as 27.2% accuracy. Of the 5 studies, 4 examined efficacy, reporting high over-triage rates (59.2%-65.0%) and mixed impacts on waiting times. While 2 studies found significant reductions in time-to-physician and time-to-triage, others reported no significant improvements following adjustments. Kiosks demonstrated high usability, with one study reporting 97% uptake among ED attendees.

CONCLUSIONS

Evidence on the safety and efficacy of digital check-in and triage kiosks remains sparse. Based on the limited number of studies available, digital kiosks appear effective in accurately identifying high-acuity patients; however, their impact on operational efficiency measures is unclear. High over-triage rates and poor concordance with nurse-assigned triage scores may limit their practical application in busy ED settings. Further research is required to evaluate long-term outcomes, implementation across diverse health care contexts, and integration into ED workflows to better understand how digital kiosks can safely and effectively help address the growing demand for EDs.

TRIAL REGISTRATION

PROSPERO CRD42024481506; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024481506.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2024-084506.