11 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
'More than words' – Interpersonal communication, cognitive bias and diagnostic errors
During the diagnostic process, clinicians may make assumptions, prematurely judge or diagnose patients based on their appearance, their speech or how they are portrayed by other clinicians. Such judgements can be a major source of diagnostic error and are often linked to unconscious cognitive biases - faulty quick-fire thinking patterns that impact clinical reasoning. Patient safety is profoundly influenced by cognitive bias and language, i.e. how information is presented or gathered, and then synthesised by clinicians to form and communicate diagnostic decisions. Here, we discuss the intricate links between interpersonal communication, cognitive bias, and diagnostic error from a patient’s, a linguist’s and clinician’s perspective. We propose that through patient engagement and applied health communication research, we can enhance our understanding of how the interplay of communication behaviours, biases and errors can impact upon the patient experience and diagnostic error. In doing so, we provide new avenues for collaborative diagnostic error research striving towards healthcare improvements and safer diagnosis
Piloting an online incident reporting system in Australasian emergency medicine
Background: Medical-specific incident reporting systems are critical to understanding error in healthcare but underreporting by doctors reduces their value. Objective: We conducted a pilot study of the implementation of an online ED-specific incident reporting system in Australasian hospitals and evaluated its use. Methods: The reporting system was based on the literature and input of experts. Thirty-one hospital EDs were approached to pilot the Emergency Medicine Events Register (EMER). The pilot evaluated: website usage and analytics, reporting behaviours and rates, the quality of information collected in EMER. Semi-structured interviews of three site champions responsible for implementing EMER were conducted. Results: Seventeen EDs expressed interest; however, due to delays and other barriers reporting only occurred at three sites. Over 354 days, the website received 362 unique visitors and 77 incidents. The median time to report was 4.6min. The reporting rate was 0.07 reports per doctor month, suggesting a reporting rate of 0.08% of ED presentations. Data quality, as measured by the number of completed non-mandatory fields and ability to classify incidents, was very high. The interviews identified enablers (the EMER system, site champions) and barriers (chiefly the context of EM) to EMER uptake. Conclusions: Collecting patient safety information by frontline doctors is essential to actively engage the profession in patent safety. Although the EMER system allowed easy online reporting of high quality incident data by doctors, site recruitment and system uptake proved difficult. System use by ED doctors requires dedicated and conscious effort from the profession
The emergency medicine events register: an analysis of the first 150 incidents entered into a novel, online incident reporting registry
Objective: Incident reporting systems are critical to understanding adverse events, in order to create preventative and corrective strategies. There are very few systems dedicated to Emergency Medicine with published results. All EDs in Australia and New Zealand were contacted to encourage the use of an Emergency Medicine – specific online reporting system called the Emergency Medicine Events Register (EMER). Methods: We conducted an analysis of the first 150 incidents entered into EMER. EMER captures Emergency-medicine-specific details including triage score, clinical presentation, outcome, contributing factors, mitigating factors, other specialities involved and patient journey stage. These details were analysed by an expert panel. Results: Over the first 26\ua0months, 150 incidents were reported into EMER. The most common categories reported, in order, were diagnostic error, procedural complication and investigation errors. Most incidents contained more than one category of error. The most common stage of the patient's journey in which an incident was detected was after discharge from the ED. Conclusion: A focus on correct diagnosis, procedure performance and investigation interpretation may reduce errors in the ED. The ability to learn from incidents and make system changes to enhance patient safety in healthcare organisations is an inherent part of providing a proactive, quality culture
The effectiveness of cultural competence programs in ethnic minority patient-centered health care : a systematic review of the literature
Purpose. To examine the effectiveness of patient-centered care (PCC) models, which incorporate a cultural competence (CC) perspective, in improving health outcomes among culturally and linguistically diverse patients. Data sources. The search included seven EBSCO-host databases: Academic Search Complete, Academic Search Premier, CINAHL with Full Text, Global Health, MEDLINE with Full Text, PsycINFO PsycARTICLES, PsycEXTRA, Psychology and Behavioural Sciences Collection and Pubmed, Web of Knowledge and Google Scholar. Study selection. The review was undertaken following the preferred reporting items for systematic reviews and meta-analyses, and the critical appraisals skill program guidelines, covering the period from January 2000 to July 2011. Data extraction. Data were extracted from the studies using a piloted form, including fields for study research design, population under study, setting, sample size, study results and limitations. Results of data synthesis. The initial search identified 1450 potentially relevant studies. Only 13 met the inclusion criteria. Of these, 11 were quantitative studies and 2 were qualitative. The conclusions drawn from the retained studies indicated that CC PCC programs increased practitioners' knowledge, awareness and cultural sensitivity. No significant findings were identified in terms of improved patient health outcomes. Conclusion. PCC models that incorporate a CC component are increased practitioners' knowledge about and awareness of dealing with culturally diverse patients. However, there is a considerable lack of research looking into whether this increase in practitioner knowledge translates into better practice, and in turn improved patient-related outcomes. More research examining this specific relationship is, thus, needed