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

2017 ◽  
Vol 25 (1) ◽  
pp. 216-224 ◽  
Author(s):  
Waqas Shuaib ◽  
John Hilmi ◽  
Joshua Caballero ◽  
Ijaz Rashid ◽  
Hashim Stanazai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Prospective Trial ◽  
Secondary Outcome ◽  
Patient Throughput ◽  
Time Motion ◽  
Physician Productivity ◽  
Relative Value ◽  
Quasi Experimental ◽  
The Impact

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

Validating the primary provider theory in emergency medicine

2008 ◽  
Vol 21 (2) ◽  
pp. 120-130 ◽  
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.

scholarly journals The impact of the coordinating nurse role on patient satisfaction in the emergency department: a semi-experimental study

2020 ◽  
Vol 7 (1) ◽  
pp. 22-27
Author(s):  
Mojtaba Samimi ◽  
Arash Safaie ◽  
Mehran Sotoodehnia ◽  
Fatemeh Rasooli ◽  
Atefeh Abdollahi
Keyword(s):  
Emergency Department ◽  
Experimental Study ◽  
Patient Satisfaction ◽  
Nurse Role ◽  
The Impact

scholarly journals P105: Observational study of distribution of time and activities over the course of an emergency physician's shift

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S102-S103
Author(s):  
E. Feng ◽  
Z. Zia ◽  
C. Tong ◽  
N. Cornell
Keyword(s):  
Medical Information ◽  
Patient Flow ◽  
Second Phase ◽  
Time Motion ◽  
Patient Interaction ◽  
Physician Productivity ◽  
Motion Study ◽  
One Year ◽  
The Impact ◽  
Insight Into

Introduction: The growing scrutiny to improve Emergency Department (ED) wait times and patient flow have resulted in many efforts to increase efficiency and maximize patient throughput via systems improvements. This study investigates areas of efficiency improvement from the Emergency Physician (EP) perspective by examining EP workflow in a two phased observational time-motion study. In the initial phase, the distribution of time and activities of EPs were dissected to identify potential sources for streamlining to maximize physician productivity. The first phase was of the study was completed during the period immediately preceding the implementation of an Electronic Health Records (EHR). The second phase of the study will repeat the analysis one year post EHR implementation. This data will be dissected to again identify sources for streamlining in an EHR environment and to identify shifts in work flow from a paper-based system. Methods: An observational time motion study was conducted at St. Mary's Hospital ED, in Kitchener Ontario. An observer was paired with an EP for the duration of an 8 hour shift, to a total of 14 shifts in the first phase of the study. Nine task categories were measured concurrently with a stopwatch application on a tablet, along with the number of interruptions experienced by the EP. Means of each category were calculated and converted to percentages, representing the amount of time per 8 hour shift dedicated to each activity. The second phase will be repeated in Fall 2020, 1 year after EHR implementation. Results: A total of 14 shifts were observed, accounting for 112 hours of observation. EP's time was allocated amongst the following categories: direct patient interaction (40.8%), documentation (27.1%), reviewing patient results (18.4%), communicating with ED staff (7.63%), personal activities (5.7%), writing orders (5.1%), communicating with consultants (3.3%), teaching (1.7%) and medical information searches (1.3%). On average, EPs experienced 15.8 interruptions over the course of an 8 hour shift. Conclusion: In a paper charting system, the direct patient interaction accounts for the largest timeshare over the course of a given shift. However, the next two largest categories, documentation and reviewing patient data, both represent areas of potential streamlining via clerical improvements. Additionally, detailed measurements of EPs’ activities have proven feasible and provides the potential for future insight into the impact of EHR's on EP workflow.

scholarly journals Comprehensive geriatric assessment in the emergency department

2020 ◽  
Vol 49 (6) ◽  
pp. 936-938 ◽  
Author(s):  
Siobhan Harding
Keyword(s):  
Emergency Department ◽  
Secondary Care ◽  
Evidence Base ◽  
Community Dwelling ◽  
Multiple Sources ◽  
National Guidelines ◽  
Post Discharge ◽  
Post Intervention ◽  
Quasi Experimental ◽  
The Impact

Abstract Completing comprehensive geriatric assessments (CGA) for frail patients admitted to acute hospitals has well-established benefits and is advocated by national guidelines. There is high-quality evidence demonstrating an association between inpatient CGAs and the patient being alive and community-dwelling at 12-month follow-up. However, less well-known is the effectiveness of CGAs conducted within the emergency department (ED), with the primary purpose of facilitating admission avoidance, on reducing 30-day reattendance or readmission. This commentary provides an overview of five studies that measure the impact of conducting an ED-CGA on subsequent secondary care attendance. Two randomised-controlled trials, one case-matched cohort study and two quasi-experimental pre- and post-intervention studies were reviewed. The studies reported variable success in preventing subsequent secondary care use. No studies meeting the criteria had been conducted within the UK, affecting generalisability of the findings. There is no clear evidence that conducting a CGA within ED reduced reattendances or admissions 30 days post-discharge. The existing evidence base is methodologically and clinically heterogeneous and is vulnerable to multiple sources of bias. Further research is needed to understand whether screening to identify target populations or whether increased intensity of interventions delivered improves outcomes. ED-CGA may not have a beneficial effect on cost improvement or service delivery metrics, but it may have positive outcomes that are of high importance to the patients. This warrants further study.

scholarly journals P003: Door-to-antibiotics and mortality for emergency department patients presenting with septic shock

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S64
Author(s):  
A. Aguanno ◽  
K. Van Aarsen ◽  
S. Pearce ◽  
T. Nguyen
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Linear Regression ◽  
Hospital Discharge ◽  
Statistical Significance ◽  
Serum Lactate ◽  
Secondary Outcome ◽  
Clinical Equipoise ◽  
Time To Antibiotics ◽  
The Impact

Introduction: We examined our local sepsis patient population, and specifically our most vulnerable patients - those presenting to the emergency department (ED) in septic shock - for variables predictive of survival to hospital discharge. We applied the familiar ED paradigm of, “Door to,” to calculate the impact of time to antibiotics against patient survival to hospital discharge. Methods: Retrospective chart review of patients aged &gt; = 18 years, presenting to tertiary care ED between 01 Nov 2014 and 31 Oct 2015. Patients determined to have sepsis if A) &gt; = 2 SIRS criteria and ED suspicion of infection (ED acquisition of blood/urine cultures or antibiotic administration) and/or B) received ED or Hospital discharge diagnosis of sepsis (ICD-10 diagnostic codes A4xx and R65). Patients sub-classified with septic shock if A) triage SBP &lt; = 90mmHg, B) triage MAP &lt; = 65mmHg or C) serum lactate &gt; = 4mmol/L. “Door Time” was defined as the earliest time recorded for the patient encounter, either the time the patient registered in the Emergency Department, or the triage time. A generalized linear model was performed with a binomial distribution using survival to discharge as the response variable. Age, sex, ED arrival method, time to antibiotics, ED serum lactate and ED serum glucose level were the predictor variables. Results: 13506 patient encounters met inclusion criteria (10980 unique patients). Linear regression of time to antibiotics against survival to hospital discharge failed to achieve statistical significance. Linear regression of the secondary outcome variables achieved statistical significance for age and serum lactate level. Per the model, as age increased by 1 year, the odds of dying prior to hospital discharge increased by 3.8% and as serum lactate increased by 1 mmol/L, odds of dying prior to hospital discharge increased by 11.1%. Conclusion: We found no association between time to antibiotic treatment and mortality. Causal relationships require randomized controlled trials, and this analysis contributes to clinical equipoise.

An innovative short-stay health care model for treatment of uncomplicated vaso-occlusive crisis in adult sickle cell disease patients in Canada to reduce emergency department utilization

CJEM ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Andrew Binding ◽  
Richard Ward ◽  
Chai Phua ◽  
Veronique Naessens ◽  
Tara O’Brien ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Discharge Rate ◽  
Historical Control ◽  
Secondary Outcome ◽  
Emergency Department Utilization ◽  
Short Stay ◽  
Cell Disease

AbstractObjectivesPatients with sickle cell disease (SCD) with vaso-occlusive crises (VOC) often visit the emergency department (ED) for management of painful episodes. The primary objective of this pilot study was to evaluate the acceptability of a short-stay model for treatment of VOC in SCD outside of the ED in Toronto, Canada. Secondary objectives were to assess patient satisfaction of this model, barriers to its use and comparison of clinical outcomes to a historical control.MethodsAdult SCD patients with symptoms of an uncomplicated VOC between October 2014 to July 2016 were managed according to best practice recommendations in a short-stay unit as an alternative to the local emergency room. Primary outcome of time to first analgesia, and secondary outcome of discharge rate were compared to a historical control at a local ED from 2009-2012. Satisfaction and barriers to use of the ambulatory care delivery model were assessed by patient survey.ResultsTwenty-one visits were recorded at the short-stay unit during the study period. Average time to first opiate dose was 23.5 minutes in the short-stay unit compared to 100.3 minutes in the ED (p<0.001). Discharge rate from the short-stay unit was 84.2%. Average patient satisfaction with this model of care was high (>4/5 on Likert scale) except for geographic accessibility (85% response rate, n=18).ConclusionThis study demonstrated high patient satisfaction and acceptability of a short-stay model for treatment of uncomplicated VOC in adult SCD patients in Toronto, the first of its kind in Canada.

scholarly journals Can antipoverty programmes save lives? Quasi-experimental evidence from the Earned Income Tax Credit in the USA

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037051
Author(s):  
Peter Muennig ◽  
Daniel Vail ◽  
Jahn K Hakes
Keyword(s):  
Outcome Measures ◽  
Income Tax ◽  
State Level ◽  
Earned Income Tax Credit ◽  
Secondary Outcome ◽  
Tax Credit ◽  
Earned Income ◽  
Quasi Experimental ◽  
The Usa ◽  
The Impact

ObjectiveTo estimate the impact of state-level supplements of the Earned Income Tax Credit (EITC) on mortality in the USA. The EITC supplements the wages of lower-income workers by providing larger returns when taxes are filed.SettingNationwide sample spanning 25 cohorts of people across every state in the USA.Participants793 000 respondents within the National Longitudinal Mortality Survey (NLMS) between 1986 and 2011, a representative sample of the USA.InterventionState-level supplementation to the EITC programme. Some, but not all, states added EITC supplementation to varying degrees beginning in 1986 (Wisconsin) and most recently in 2015 (California). Participants who were eligible in states with supplementary programmes were compared with those who were not eligible for supplementation. Comparisons were made both before and after implementation of the supplementary programme (a difference-in-difference, intent-to-treat analysis). This quasi-experimental approach further controls for age, gender, marital status, race or ethnicity, educational attainment, income and employment status.Primary and secondary outcome measuresThe primary outcome measure was survival at 10 years. Secondary outcome measures included survival at 5 years and survival to the end of the intervention period.ResultsWe find an association between state supplemental EITC and survival, with a HR of 0.973 (95% CI=0.951–0.996) for each US$100 of EITC increase (p<0.05).ConclusionState-level supplemental EITC may be an effective means of increasing survival in the USA.

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