6 research outputs found
Impact of scribes on emergency medicine doctors' productivity and patient throughput: Multicentre randomised trial
Objectives
To evaluate the changes in productivity when scribes
were used by emergency physicians in emergency
departments in Australia and assess the effect of
scribes on throughput.
Design
Randomised, multicentre clinical trial.
Setting
Five emergency departments in Victoria used
Australian trained scribes during their respective
trial periods. Sites were broadly representative of
Australian emergency departments: public (urban,
tertiary, regional referral, paediatric) and private, not
for profit.
Participants
88 physicians who were permanent, salaried
employees working more than one shift a week and
were either emergency consultants or senior registrars
in their final year of training; 12 scribes trained at one
site and rotated to each study site.
Interventions
Physicians worked their routine shifts and were
randomly allocated a scribe for the duration of their
shift. Each site required a minimum of 100 scribed
and non-scribed shifts, from November 2015 to
January 2018.
Main outcome measures
Physicians’ productivity (total patients, primary
patients); patient throughput (door-to-doctor time,
length of stay); physicians’ productivity in emergency
department regions. Self reported harms of scribes
were analysed, and a cost-benefit analysis was done Results
Data were collected from 589 scribed shifts (5098
patients) and 3296 non-scribed shifts (23838
patients). Scribes increased physicians’ productivity
from 1.13 (95% confidence interval 1.11 to 1.17)
to 1.31 (1.25 to 1.38) patients per hour per doctor,
representing a 15.9% gain. Primary consultations
increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to
1.11) patients per hour per doctor, representing a
25.6% gain. No change was seen in door-to-doctor
time. Median length of stay reduced from 192
(interquartile range 108-311) minutes to 173 (96-
208) minutes, representing a 19 minute reduction
(P<0.001). The greatest gains were achieved by placing
scribes with senior doctors at triage, the least by using
them in sub-acute/fast track regions. No significant
harm involving scribes was reported. The cost-benefit
analysis based on productivity and throughput gains
showed a favourable financial position with use of
scribes.
Co nclusions
Scribes improved emergency physicians’ productivity,
particularly during primary consultations, and
decreased patients’ length of stay. Further work
should evaluate the role of the scribe in countries with
health systems similar to Australia’s.The study was funded by Equity Trustees, the Phyllis Connor
Memorial Fund, Cabrini Foundation, and Cabrini and supported by
the Cabrini Institut
Effects of attention on a relative mislocalization with successively presented stimuli
Previous studies yielded evidence that the precision, with which stimuli are localized in the visual periphery, is improved under conditions of focused attention. The present study examined whether focused attention is able to correct a mislocalization recently observed with successively presented stimuli:
when observers are asked to localize the peripheral position of a briefly presented target with respect to a previously presented comparison stimulus, they tended to judge the target as being more towards the fovea than was its actual position. In three experiments the mislocalization was tested under conditions with focused and distributed attention. Results revealed that the mislocalization increased with distributed
attention and disappeared when stimuli appeared consistently at predictable positions and thus under conditions of focused attention. However, when a procedure with a trial-by-trial cueing was applied the mislocalization was only reduced, but not wiped out completely. In a recently developed
dynamic field model consisting of interacting excitatory and inhibitory neuronal cell populations the results were explained as an attentional modulation of spontaneous (baseline) levels of neural activity.Fundação para a Ciência e a Tecnologia (FCT)Deutsche Forschungsgemeinschaft - DFG MU 1298/
The quality of medical record review studies in the international emergency medicine literature
Study objective: We assess the methodologic quality of studies using medical record review
methodology in 4 international emergency medicine journals. A secondary aim was to compare
methodology quality among these journals and across years.
Methods: This was an observational study of articles whose main methodology was medical record
review published in Academic Emergency Medicine (AEM), Annals of Emergency Medicine (Annals),
Emergency Medicine Journal (EMJ), and Emergency Medicine Australasia (EMA) between January
2002 and May 2004. Eligible articles were reviewed for reporting of a clear hypothesis or objective,
training of abstractors, defined inclusion and exclusion criteria, use of a standard abstraction form,
definition of important variables, monitoring of abstractor performance, blinding of abstractors to
study hypothesis, reporting of interrater reliability, sample size or power calculation, reporting of
ethics approval or waiver, and disclosure of funding source. The primary outcome was the proportion
of articles meeting each criterion. Secondary outcomes were comparison of the proportions of
articles meeting each criterion among journals and by years.
Results: One hundred seven articles were analyzed; 31 were published in AEM, 29 in Annals, 29 in
EMJ, and 18 in EMA. A clear aim was reported in 93% of articles, standardized abstraction forms
were reported in 51%, interrater reliability was reported in 25%, ethics approval or waiver was
reported in 68%, and sample size or power calculation was reported in 10%.
Conclusion: Adherence to the quality criteria for medical record reviews was suboptimal, and there
were significant differences among journals in overall methodologic quality