Emergency Department kiosks at RVH improve check-ins, patient flow

Patients arriving at the Royal Victoria Regional Health Centre’s (RVH) Emergency Department (ED) in Barrie, Ontario, used to encounter a lineup as soon as they walked in the door. With between 270 and 350 patients seeking emergency care every day, patients often ended up waiting in line to identify themselves and share their reason for seeking emergency care.

But that’s no longer the case since the installation of Savience Ltd.’s self-serve check-in kiosks just inside the ED’s entrance.

“Previously, we had a staff member working on a computer checking in each person in a single queue, one at a time,” said ED manager Ray Howald. “Now, two patients can check in simultaneously, resulting in a 30 to 60 percent reduction in the time it takes to check-in to the ED.”

The hospital has also seen a 20-30 percent reduction in clerical workload in the ED and a 15 to 25 percent reduction in the time it takes for triage nurses to prioritize patients reporting serious health concerns.

Patients check-in at the Savience kiosk by scanning their health card and selecting their chief complaint from lists on the kiosk screen.

They’re also asked to report if they have any cough, cold or flu symptoms. The information provided is instantly available to the triage nurses, who can prioritize patients reporting chest pains or other serious conditions and don personal protective equipment as required for infection prevention and control.

“The kiosks don’t independently decide who should be seen first,” said Howald. It’s still the clinical lens of the triage nurse that makes these decisions, but it’s the kiosk that helps the nurses identify patients who are in need of expedited care.

The Savience technology is integrated with the hospital’s MEDITECH Expanse information system, speeding the registration process for patients who have a history with RVH, explained Sarabjit Singh, RVH’s regional chief nursing informatics officer.

The check-in process finishes with the kiosk printing out a ticket with a randomized number instructing patients to have a seat in the waiting room until their number is called.

“Previously, the triage nurse would call the person’s name out loud in the waiting room,” said Howald. Now a patient calling module in the waiting room displays and announces ticket numbers on an overhead monitor, ensuring more privacy for patients than calling them by name.

Patients, triage nurses and registration staff all benefit from the Savience system. Patients spend less time waiting to check-in and with ticket in hand, they know they’re in the queue, said Howald. “That helps mitigate any frustration.”

Triage nurses don’t miss having to “yell out the next patient’s name,” appreciate being able to prioritize patients with more acute or critical presentations, and welcome advance notification of the need to protect themselves with PPE, he added.

The Savience system also helps to reduce the workload for registration staff because information they had to collect and enter themselves is now automatically transmitted to MEDITECH when patients scan their health cards during the check-in process.

The installation of the check-in system at the RVH emergency department wasn’t the hospital’s first experience with Savience technology. In 2019, it acquired Savience kiosks for patients checking in to its outpatient clinics.

Hospital leaders decided to acquire the technology because of the growing number of patients and the challenges associated wait times in hopes to improve patient flow, said Jen Haines, manager of patient access.

RVH has 32 outpatient clinics spread throughout the hospital, but there are also several offsite locations. An outpatient cancer clinic is scheduled to be added to the Savience system September 15, leaving only a few clinics – imaging and mental health, for example – to rely on conventional check-in procedures.

Kiosks are located at all three of RVH’s main entrances, allowing patients to register upon entering the hospital. They scan their health card, complete their registration and receive a ticket providing them with wayfinding information for the outpatient clinic they’re attending. Staff in the clinic are alerted electronically of a patient’s arrival when the registration is completed.

Savience has also developed the functionality to allow patients to check in on their smartphones, said Amy Bellisle, RVH’s regional manager, clinical informatics.

They simply scan a QR code that launches the same interface as the kiosk. Instead of a physical ticket, the system generates a randomized number on their phone together with details on where to go and how to get there if patients are navigating to surgery or an outpatient clinic.

“Using their smartphones to check-in effectively gives patients a kiosk in their pocket,” said Savience account manager Shaun Fagan.” RVH is not yet offering this optional check-in process but may consider taking advantage of it in the future, said Bellisle.

The more recent introduction of the technology in the ED was a result of the efficiency gains RVH experienced in registering patients for its outpatient clinics. Selecting Savience as its vendor of choice also made sense because the hospital was already using its technology and an integration with its MEDITECH health information system was already in place, said Howald.

Based in Towcester in the United Kingdom, northwest of London, Savience serves hospitals in the UK, Ireland and Canada. The company entered the Canadian market through an initial deployment at Quinte Health’s Belleville General Hospital, followed by implementations at Lennox and Addington County General Hospital in Napanee, Ont., and the William Osler Health System in Brampton, Ont.

A Savience Canada subsidiary was established in 2017 and today, there are more than 40 hospitals across Ontario using its check-in kiosks. The company has an office in Burlington, Ontario.

ED staff at RVH worked closely with Savience personnel to redesign the workflow in the department, relying on their past experience, lessons learned and opportunities for increased efficiencies.

One idea incorporated into the design of the ED kiosks acknowledges the fact that not everyone showing up at the ED is there for emergency care.

“That was one of the lessons we learned from a partner site,” said Howald. “Some patients arriving for day surgery or an appointment in an outpatient clinic mistakenly enter the hospital through the ED, so the first question the kiosk asks is ‘Are you here to see an emergency physician, or are you checking in for surgery or an outpatient clinic appointment?’”

If the patient is indeed checking in for day surgery or an outpatient appointment, the ticket that prints out provides wayfinding information based on their location in the ED.

The kiosks in the ED aren’t used for patients arriving by ambulance. They arrive in the ED through a different entrance and are triaged separately. However, ambulance arrivals are still identified in the Savience list of patients with an accompanying ambulance icon.

“Savience has been fantastic,” said Haines. “I wasn’t here when they were selected but I would highly recommend them just because they are so responsive. They do site visits and they have a dedicated support team and on-site technicians, so they’re very good at providing at-the-elbow support.”

“Our technology is designed to make accessing and moving through healthcare simpler for patients, while giving hospitals better visibility and control over patient flow,” said Savience account manager Fagan. “By allowing patients to check-in, confirm their details and receive clear information through our kiosks or their own mobile devices, we can reduce queues and repetitive administrative work. That releases staff time for direct patient care and gives patients a faster, clearer and less stressful experience.”

He added, “Looking ahead, we expect continued evolution of the platform to incorporate more advanced automation and intelligence, including the responsible use of AI … We have also explored and developed optional identity verification technologies, including facial recognition in appropriate and consent-driven contexts, to further streamline check-in processes and reduce administrative friction while maintaining strict privacy and security standards.”

Other areas of ongoing development include digital triage and streaming, improved real-time operational dashboards, more flexible patient communications and deeper integration with hospitals’ existing electronic medical record systems.

“The aim is to create a more connected journey from appointment booking and reminders through arrival, care delivery and outcome, while giving hospitals better data with which to manage capacity and demand,” said Fagan.