Implementation of Scribes in an Academic Emergency Department: The Resident Perspective

ABSTRACT Background Medical scribes have been shown to improve emergency department (ED) throughput, physician productivity metrics, and patient satisfaction by fulfilling primary documentation and nonclinical functions. Little research has been done to date to study the effect of implementing a scribe program in a residency setting. Objective Our goal was to investigate emergency medicine residents' perception of their educational experience, including interactions with faculty, before and after the implementation of an ED scribe program. Methods We used a pre-post design to assess residents' perceptions of their educational experience before and after implementation of the scribe program. Residents at a large, urban academic medical center with an Accreditation Council for Graduate Medical Education–accredited, 4-year emergency medicine residency program were surveyed during August 2015 (prior to the implementation of the scribe program) and April 2016 (6 months after implementation). Results Residents reported improved educational experiences with statistically significant changes in the following areas: increased interaction with faculty due to fewer documentation requirements (P = .012); more face-to-face teaching with faculty (P < .001); increased faculty supervision for procedures (P = .016); and a decrease of delays in patient disposition due to incomplete documentation (P = .029). Conclusions Implementation of an ED scribe program in an urban 4-year emergency medicine residency program led to improvements in residents' perceptions of their education.

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Privileging pharmacists improves time to patient notification in the microbiological test review process for patients discharged from the emergency department

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz335 ◽

2020 ◽

Vol 77 (Supplement_1) ◽

pp. S19-S24

Author(s):

Steven M Loborec ◽

Jose A Bazan ◽

Nicole V Brown ◽

Mary Beth Shirk ◽

Trisha A Jordan

Keyword(s):

Emergency Department ◽

Medical Center ◽

Academic Medical Center ◽

Test Results ◽

Infectious Disease Physician ◽

Microbiological Test ◽

Test Review ◽

Academic Medical ◽

Before And After ◽

The Impact

Abstract Purpose Results of a study evaluating the impact of privileging pharmacists to manage microbiologic test results for patients discharged from the emergency department (ED) are reported. Methods This was a single-center, retrospective pre-post study that was conducted at an urban academic medical center. Patients discharged from the ED with a subsequent positive microbiologic test result before and after privileging of an ED specialty practice pharmacist (ED-SPP) to manage the results independently were screened for inclusion. Time to patient notification of a required change in antimicrobial therapy was compared between groups. Numbers of erroneous interventions before and after pharmacist privileging were compared to assess the safety of implementation. Results One hundred seventy-eight positive microbiologic test results (n = 92 pre- and n = 86 postimplementation) were included. The median time to patient notification in the pre-implementation group was 23.6 hours (range, 12.4-93 hours) and in the postimplementation group was 14.9 hours (range, 2.5-27.9 hours; P = 0.0023). As determined by the board-certified infectious disease physician, 1.1% of reviewed microbiologic test results (1 of 92) was erroneous prior to implementation of pharmacist privileging compared with 2.3% (2 of 86) after implementation (P = 0.6105). Conclusion Privileging ED-SPPs to assess microbiologic test results improved the time to patient notification with no statistical difference in the number of erroneous interventions between groups. These findings demonstrate the benefit of clinical privileging and provide support for expansion of this role to other ED-SPPs.

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Evaluating the association between COVID-19 and psychiatric presentations, suicidal ideation in an emergency department

PLoS ONE ◽

10.1371/journal.pone.0253805 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253805

Author(s):

Michal J. McDowell ◽

Carrie E. Fry ◽

Mladen Nisavic ◽

Mila Grossman ◽

Charles Masaki ◽

...

Keyword(s):

Emergency Department ◽

Time Series ◽

Suicidal Ideation ◽

Medical Center ◽

Academic Medical Center ◽

Interrupted Time Series ◽

Electronic Health Record Data ◽

Percentage Points ◽

Before And After ◽

Differential Increase

Objective To estimate the association between COVID-19 and Emergency Department (ED) psychiatric presentations, including suicidal ideation. Methods Using an interrupted time series design, we analyzed psychiatric presentations using electronic health record data in an academic medical center ED between 2018 and 2020. We used regression models to assess the association between the onset of the COVID-19 outbreak and certain psychiatric presentations. The period February 26–March 6, 2020 was used to define patterns in psychiatric presentations before and after the coronavirus outbreak. Results We found a 36.2% decrease (unadjusted) in ED psychiatric consults following the coronavirus outbreak, as compared to the previous year. After accounting for underlying trends, our results estimate significant differential change associated with suicidal ideation and substance use disorder (SUD) presentations following the outbreak. Specifically, we noted a significant differential increase in presentations with suicidal ideation six weeks after the outbreak (36.4 percentage points change; 95% CI: 5.3, 67.6). For presentations with SUD, we found a differential increase in the COVID-19 time series relative to the comparison time series at all post-outbreak time points and this differential increase was significant three weeks (32.8 percentage points; 95% CI: 4.0, 61.6) following the outbreak. Our results estimate no differential changes significant at the P value < 0.05 level associated with affective disorder or psychotic disorder presentations in the COVID-19 time series relative to the comparator time series. Conclusions The COVID-19 outbreak in Boston was associated with significant differential increases in ED presentations with suicidal ideation and SUD.

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Learning Clinical Versus Leadership Competencies in the Emergency Department: Strategies, Challenges, and Supports of Emergency Medicine Residents

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00193.1 ◽

2011 ◽

Vol 3 (3) ◽

pp. 320-325 ◽

Cited By ~ 17

Author(s):

Ellen F Goldman ◽

Margaret M Plack ◽

Colleen N Roche ◽

Jeffrey P Smith ◽

Catherine L Turley

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Learning Process ◽

Medical Center ◽

Academic Medical Center ◽

Leadership Skills ◽

Clinical Skill ◽

Skill Learning ◽

Formal Leadership ◽

Attending Physicians

Abstract Background Emergency medicine residents are expected to master 6 competencies that include clinical and leadership skills. To date, studies have focused primarily on teaching strategies, for example, what attending physicians should do to help residents learn. Residents' own contributions to the learning process remain largely unexplored. The purpose of this study was to explore what emergency medicine residents believe helps them learn the skills required for practice in the emergency department. Methods This qualitative study used semistructured interviews with emergency medicine residents at a major academic medical center. Twelve residents participated, and 11 additional residents formed a validation group. We used phenomenologic techniques to guide the data analysis and techniques such as triangulation and member checks to ensure the validity of the findings. Results We found major differences in the strategies residents used to learn clinical versus leadership skills. Clinical skill learning was approached with rigor and involved a large number of other physicians, while leadership skill learning was unplanned and largely relied on nursing personnel. In addition, with each type of skills, different aspects of the residents' personalities, motivation, and past nonclinical experiences supported or challenged their learning process. Conclusion The approaches to learning leadership skills are not well developed among emergency medicine residents and result in a narrow perspective on leadership. This may be because of the lack of formal leadership training in medical school and residency, or it may reflect assumptions regarding how leadership skills develop. Substantial opportunity exists for enhancing emergency medicine residents' learning of leadership skills as well as the teaching of these skills by the attending physicians and nurses who facilitate their learning.

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Application of a Computer Vision Tool for Automated Glottic Tracking to Vocal Fold Paralysis Patients

Otolaryngology ◽

10.1177/0194599821989608 ◽

2021 ◽

pp. 019459982198960

Author(s):

Tiffany V. Wang ◽

Nat Adamian ◽

Phillip C. Song ◽

Ramon A. Franco ◽

Molly N. Huston ◽

...

Keyword(s):

Vocal Fold ◽

Assessment Tool ◽

Medical Center ◽

Characteristic Curve ◽

Academic Medical Center ◽

Vocal Fold Paralysis ◽

Control Group ◽

Large Patient ◽

Patient Reported ◽

Before And After

Objectives (1) Demonstrate true vocal fold (TVF) tracking software (AGATI [Automated Glottic Action Tracking by artificial Intelligence]) as a quantitative assessment of unilateral vocal fold paralysis (UVFP) in a large patient cohort. (2) Correlate patient-reported metrics with AGATI measurements of TVF anterior glottic angles, before and after procedural intervention. Study Design Retrospective cohort study. Setting Academic medical center. Methods AGATI was used to analyze videolaryngoscopy from healthy adults (n = 72) and patients with UVFP (n = 70). Minimum, 3rd percentile, 97th percentile, and maximum anterior glottic angles (AGAs) were computed for each patient. In patients with UVFP, patient-reported outcomes (Voice Handicap Index 10, Dyspnea Index, and Eating Assessment Tool 10) were assessed, before and after procedural intervention (injection or medialization laryngoplasty). A receiver operating characteristic curve for the logistic fit of paralysis vs control group was used to determine AGA cutoff values for defining UVFP. Results Mean (SD) 3rd percentile AGA (in degrees) was 2.67 (3.21) in control and 5.64 (5.42) in patients with UVFP ( P < .001); mean (SD) 97th percentile AGA was 57.08 (11.14) in control and 42.59 (12.37) in patients with UVFP ( P < .001). For patients with UVFP who underwent procedural intervention, the mean 97th percentile AGA decreased by 5 degrees from pre- to postprocedure ( P = .026). The difference between the 97th and 3rd percentile AGA predicted UVFP with 77% sensitivity and 92% specificity ( P < .0001). There was no correlation between AGA measurements and patient-reported outcome scores. Conclusions AGATI demonstrated a difference in AGA measurements between paralysis and control patients. AGATI can predict UVFP with 77% sensitivity and 92% specificity.

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Implementation of a Leeches + Antimicrobial Prophylaxis Order Panel to Optimize Medicinal Leech Use at a Tertiary Care Academic Medical Center

Journal of Pharmacy Practice ◽

10.1177/0897190021993683 ◽

2021 ◽

pp. 089719002199368

Author(s):

Nicole M. Palm ◽

Jill C. Wesolowski ◽

Janet Y. Wu ◽

Pavithra Srinivas

Keyword(s):

Antimicrobial Prophylaxis ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Medicinal Leech ◽

Aeromonas Species ◽

Leech Therapy ◽

Before And After ◽

Timing Of Initiation ◽

Medicinal Leeches

Medicinal leech therapy promotes vascular flow and can be used to salvage grafts. Medicinal leeches have a symbiotic relationship with Aeromonas species and can therefore present a risk of bacterial transmission to patients. Antimicrobial prophylaxis is warranted for the duration of leech therapy, however, an institutional evaluation of 40 patients receiving medicinal leech therapy demonstrated poor adherence with recommendations. An electronic medical record order panel for antimicrobial prophylaxis with medicinal leech therapy was implemented, leading to a subsequent improvement in adherence to prophylaxis use, including significant increases in the ordering of antibiotics and the appropriate timing of initiation in the subsequent 10 patients receiving medicinal leech therapy after panel implementation. Aeromonas infections were rare before and after panel implementation, and developed only in the patient subset with non-optimized prophylaxis.

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A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

Western Journal of Emergency Medicine ◽

10.5811/westjem.2019.11.44139 ◽

2019 ◽

Vol 21 (1) ◽

pp. 149-151 ◽

Cited By ~ 1

Author(s):

Ashley Rider ◽

Tiffany Anaebere ◽

Mariko Nomura ◽

David Duong ◽

Charlotte Wills

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Interprofessional Education ◽

Hospital Setting ◽

Scope Of Practice ◽

Registered Nursing ◽

Interprofessional Training ◽

Before And After ◽

Team Based Care ◽

Improve Health

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.

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Using design and innovation principles to reduce avoidable emergency department visits among employees of a large academic medical center

Healthcare ◽

10.1016/j.hjdsi.2020.100514 ◽

2021 ◽

Vol 9 (1) ◽

pp. 100514

Author(s):

Krisda H. Chaiyachati ◽

Katy Mahraj ◽

Carolina Garzon Mrad ◽

Christina J. O'Malley ◽

Marguerite Balasta ◽

...

Keyword(s):

Emergency Department ◽

Medical Center ◽

Academic Medical Center ◽

Emergency Department Visits ◽

Academic Medical

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Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020486 ◽

2021 ◽

Vol 18 (2) ◽

pp. 486

Author(s):

Pavani Rangachari ◽

Jie Chen ◽

Nishtha Ahuja ◽

Anjeli Patel ◽

Renuka Mehta

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Risk Factor ◽

Childhood Asthma ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Primary Research ◽

Ed Visits ◽

The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

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