Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department

Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician’s efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor–patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p < 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics

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Patient Suggestions to Improve Emergency Physician Empathy and Communication

Journal of Patient Experience ◽

10.1177/2374373521996981 ◽

2021 ◽

Vol 8 ◽

pp. 237437352199698

Author(s):

Sophia Aguirre ◽

Kristen M Jogerst ◽

Zachary Ginsberg ◽

Sandeep Voleti ◽

Puneet Bhullar ◽

...

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Emergency Physician ◽

Active Listening ◽

Patient Relationship ◽

Emergency Physicians ◽

Future Improvement ◽

Survey Responses ◽

Physician Empathy

Emergency physician empathy and communication is increasingly important and influences patient satisfaction. This study investigated if there is a need for improvement in provider empathy and communication in our emergency department and what areas could be targeted for future improvement. Patients cared for by emergency physicians with the lowest satisfaction scores were surveyed within 1 week of discharge. Patients rated their emergency provider’s empathy and communication and provided feedback on the patient–provider interaction. Compared to survey responses nationally, our providers fell between the 10th and 25th percentiles for all questions, except question 5 (making a plan of action with [the patient]) which was between the 5th and 10th percentile. Areas most frequently cited for improvement were “wanting to know why” (N = 30), “time is short” (N = 15), and “listen to the patient” (N = 13). Survey percentiles and open-ended suggestions demonstrate a need for providers to give thorough explanations, spend more time with the patient, and demonstrate active listening. These themes can be used to strengthen the provider–patient relationship.

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Development of a combined paediatric emergency department and observation unit

BMJ Open Quality ◽

10.1136/bmjoq-2019-000688 ◽

2020 ◽

Vol 9 (1) ◽

pp. e000688

Author(s):

Czer Anthoney Enriquez Lim ◽

Julie Oh ◽

Erick Eiting ◽

Catherine Coughlin ◽

Yvette Calderon ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Patient Satisfaction ◽

Patient Outcomes ◽

Close Monitoring ◽

Observation Unit ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Patient Satisfaction Scores ◽

Conversion Rates

BackgroundRecent trends towards more cost-efficient and patient-centred treatment are converging to provide opportunities to improve the care of children. Observation units are hospital areas dedicated to the ongoing evaluation and management of patients for a brief period of time for well-defined conditions. We describe the implementation of a paediatric observation unit (POU) adjacent to a paediatric emergency department (PED) in an urban, academic, community hospital.MethodsStaffing models were designed to provide paediatric services to patients in both the PED and POU. Admission criteria, workflow and transfer guidelines were developed. Quality improvement initiatives were undertaken and evaluated. Unit throughput, patient outcomes and patient satisfaction data were collected and analysed.ResultsOver a 2-year period, there were 24 038 patient visits to the PED. Of these, 1215 (5.1%) patients required admission. Seven hundred and seventy-seven (64.0%) of these children were admitted to the POU. One hundred and nineteen (15.3%) of these patients were subsequently converted to inpatient hospitalisation. The average length of stay (LOS) was 25.7 hours in 2017 and 26.5 hours in 2018. Ten patients returned to the PED within 72 hours of discharge from the POU and four were readmitted. Patient satisfaction scores regarding ‘likelihood to recommend’ improved from the 36th to the 92nd percentile rank over a 1-year period. Close monitoring of patient outcomes allowed for the adjustment of admission guidelines, increased unit census and optimised utilisation.ConclusionA combined PED-POU has been successful at our institution in meeting benchmark goals set for LOS and conversion rates. In addition, quality improvement interventions increased patient census and improved patient satisfaction scores while reducing the inpatient burden on the referring children’s hospital.

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Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/1757-7241-17-60 ◽

2009 ◽

Vol 17 (1) ◽

pp. 60 ◽

Cited By ~ 18

Author(s):

Anna Lindelius ◽

Staffan Törngren ◽

Laila Nilsson ◽

Hans Pettersson ◽

Johanna Adami

Keyword(s):

Health Care ◽

Clinical Trial ◽

Emergency Department ◽

Abdominal Pain ◽

Patient Satisfaction ◽

Randomized Clinical Trial ◽

Bedside Ultrasound ◽

Health Care Consumption

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Introduction of a modified analgesic ladder in the emergency department: Effect on oxycodone use for back pain

Journal of Opioid Management ◽

10.5055/jom.2021.0613 ◽

2021 ◽

Vol 17 (1) ◽

pp. 55-61

Author(s):

Jenny Ly, BPharm, GradCertPharmPrac ◽

Cristina P. Roman, BPharm (Hons), MPP ◽

Carl Luckhoff, MB, ChB, FACEM ◽

Peter A. Cameron, MBBS, MD, FACEM, FCEM (Hon) ◽

Michael J. BPharm, GradDipHospPharm, PhD, AdvPracPharm, FSHP, FISOPP ◽

...

Keyword(s):

Emergency Department ◽

Back Pain ◽

Outcome Measure ◽

Interquartile Range ◽

Post Intervention ◽

Community Based ◽

Analgesic Ladder ◽

Multifaceted Interventions ◽

Discharge From Hospital ◽

Modest Reduction

Objective: The aim of this study was to assess the introduction of an analgesic ladder and targeted education on oxycodone use for patients presenting to the emergency department (ED).Design: A retrospective pre-post implementation study was conducted. Data were extracted for patients presenting from June to July 2016 (preintervention) and June to July 2017 (post-intervention).Setting: The EDs of a major metropolitan health service and an affiliated community-based hospital.Participants: Patients with back pain where nonpharmacological interventions such as mobilization and physiotherapy are recommended as the mainstay of treatment.Interventions: A modified analgesic ladder introduced in May 2017. The ladder promoted the use of simple analgesics such as paracetamol and nonsteroidal anti-inflammatory drug (NSAIDs) prior to opioids and tramadol in preference to oxycodone in selected patients.Main outcome measure(s): The proportion of patients prescribed oxycodone and total doses administered.Results: There were 107 patients pre and 107 post-intervention included in this study. After implementation of the analgesic ladder, 78 (72.9 percent) preintervention patients and 55 (51.4 percent) post-intervention patients received oxycodone in ED (p = 0.001). The median oxycodone doses administered in the ED was 14 mg (interquartile range: 5-20 mg) and 5 mg (interquartile range: 5-10 mg; p 0.001), respectively. On discharge from hospital, a prescription for oxycodone was issued for 36 (33.6 percent) patients preintervention and 26 (24.3 percent) patients post-intervention (p = 0.13). Conclusions: Among patients with back pain, implementation of a modified analgesic ladder was associated with a statistically significant but modest reduction in oxycodone prescription. Consideration of multifaceted interventions to produce major and sustained changes in opioid prescribing is required.

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Why Parents Use the Emergency Department Despite Having a Medical Home

Clinical Pediatrics ◽

10.1177/0009922818809447 ◽

2018 ◽

Vol 58 (1) ◽

pp. 95-99 ◽

Cited By ~ 4

Author(s):

Kalpana Pethe ◽

Allison Baxterbeck ◽

Susan L. Rosenthal ◽

Melissa S. Stockwell

Keyword(s):

Emergency Department ◽

Low Income ◽

Medical Home ◽

Medical Problem ◽

Community Based ◽

Phone Line ◽

Medical Homes ◽

Medical Home Model ◽

After Hours ◽

Publicly Insured

Despite having a medical home, pediatric patients continue emergency department (ED) utilization for various reasons. This study examines parental reasons associated with the decision to seek ED care in a group of low-income, inner-city, publicly insured children. Surveys were conducted with parents of children (age = 0-19 years) presenting to a community-based clinic, which has an established medical home model with enhanced access. Most patients (88.3%) had a pediatrician, and nearly all (93.3%) reported a visit to the ED; most (75.7%) were aware of clinic walk-in hours, but less than half (42.6%) were aware of an after-hours phone line. There was no difference in those who were aware of walk-in hours or an after-hours phone line and a reported ED visit. Half of the parents (52.5%) thought their child’s medical problem was serious. In addition to providing enhanced efforts, medical homes should strive to make families aware of increased access.

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Validating the primary provider theory in emergency medicine

Leadership in Health Services ◽

10.1108/17511870810870565 ◽

2008 ◽

Vol 21 (2) ◽

pp. 120-130 ◽

Cited By ~ 2

Author(s):

Joseph S. Guarisco ◽

Stefoni A. Bavin

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Pay For Performance ◽

Medical Center ◽

Waiting Times ◽

Emergency Department Visits ◽

Business Success ◽

Content Type ◽

The Impact

PurposeThe purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.Design/methodology/approachThe case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.FindingsThe findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.Practical implicationsThese findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.Originality/valueThere are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.

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