Objectives: 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).Methods: 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.Results: 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. 2,3 One approach to reduce crowding has been to reroute patients with low-acuity illnesses to primary care clinics. 4 However, this approach has not had a significant effect on the problem for a variety of reasons-one being limited access to primary care for underserved patient populations, such as those seeking care at safety net EDs.
5A computer kiosk module for expedited management of UTIs was found to be accurate, acceptable, and safe in an urgent care clinic setting.6 However, it is unclear whether the technology is suitable for the ED or whether these findings can be generalized to the ED, an often chaotic environment where care is more complicated and the patient population is particularly diverse. If successful in the ED, computer kioskexpedited management of low-acuity illnesses could be an important tool in efforts to improve efficiency of care, reduce ED wait times, and ease crowding.Our aim was to assess the efficiency and safety of kiosk management for women presenting to the ED with symptoms of UTI compared with usual (traditional)
Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America.
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