Resource Utilization and Billing in a Resident-Managed Inpatient Consult Service

Objective Patient care delivered by residents is an educational opportunity to foster autonomy. These services, however, may not be billed without direct faculty supervision. This quality improvement project analyzes descriptive data, procedures, and billing from an academic otolaryngology–head and neck surgery department’s inpatient consult service. Methods This prospective cohort study collected descriptive and billing data on all consults over 30 consecutive days. Data collected described bedside procedures and operative interventions. Encounters were Current Procedural Terminology coded and equivalent work relative value unit (wRVU) calculated. Codes submitted for billing were reviewed to identify opportunities for inpatient billing improvement. Results Ninety-eight new consults were included, and 105 bedside procedures were performed. Flexible laryngoscopy (n = 27), I&D (incision and drainage; n = 11), and suturing (n = 11) were the most performed bedside procedures. Operative intervention was required in 15 encounters. The inpatient consult team provided the equivalent of 391.39 wRVU. Seventy-three percent of operative compared to 3% of bedside procedures were submitted for billing. Discussion The productivity of our team approximated 61.8% of a full-time general otolaryngologist but with decreased billing submissions. Balance between resident autonomy, education, quality patient care, and the ability to capture service revenue is complex. Strategies other institutions have used to capture missed billing opportunities have included a hospitalist model, mid-level providers, and resident billing. Implications for Practice This study characterizes an academic inpatient consult service. Results describe a case for improving the structure of the inpatient consult service, caution that studies collecting data via department billing may underrepresent services, and suggest alternative service structures to overcome identified billing limitations.

Five selected abstracts from ASCI*4010: Arts and Sciences Honours Research Seminar

This series features a selection of five abstracts from projects completed as part of the Winter 2017 iteration of ASCI*4010: Arts and Sciences Honours Research Seminar, a capstone course for students enrolled in the Bachelor of Arts and Sciences (BAS) program. The course is designed to provide students with an opportunity to integrate their research interests in the arts and sciences and to produce an extended, interdisciplinary term paper under faculty supervision. Students enrolled in the course are also given the chance to share their investigations with classmates and with the University of Guelph’s larger research community through a day of poster presentations. The abstracts collected here attest both to the interdisciplinary spirit of the BAS program and the varied research interests of its students.

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.

Community service learning: an effective vehicle for interprofessional education

Background Health professions students have limited exposure to each other during education and training, yet there are many expectations for interaction in the workplace as part of functioning health care teams. We reasoned that providing students an opportunity to work together in a service learning project under faculty supervision would enhance student knowledge and appreciation of each other’s disciplines and give them a better understanding of working together. Methods and Findings Teams of students from four disciplines (medicine, nursing, dentistry, dental hygiene) worked as volunteers with a unique population of transitional homeless families to develop individualized health and wellness plans. Pre- and post-participation surveys were used to measure changes in student perceptions of working in multi-disciplinary teams, and focus groups were used to identify strengths and weaknesses of the project and future directions. Conclusions Results showed positive predispositions to working with each other which were further enhanced by collaborative, interprofessional experience. Students’ confidence in working together in multidisciplinary teams and understanding of the training and expertise of other professions increased after participation and changes were statistically significant. Interprofessional education and community service-based learning may be a powerful combination for demonstrating the value of clinical teamwork to health professions students.