7 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
Physiciansâ productivity (total patients, primary
patients); patient throughput (door-to-doctor time,
length of stay); physiciansâ 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 physiciansâ 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 physiciansâ productivity,
particularly during primary consultations, and
decreased patientsâ length of stay. Further work
should evaluate the role of the scribe in countries with
health systems similar to Australiaâs.The study was funded by Equity Trustees, the Phyllis Connor
Memorial Fund, Cabrini Foundation, and Cabrini and supported by
the Cabrini Institut
Randomised controlled trial of the short-term effects of OROS-methylphenidate on ADHD symptoms and behavioural outcomes in young male prisoners with attention-deficit/hyperactivity disorder (CIAO-II)
Background
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder, seen in 20â30% of young adult prisoners. Pharmacoepidemiological studies, a small randomised controlled trial and open trial data of methylphenidate suggest clinically significant reductions in ADHD symptoms, emotional dysregulation, disruptive behaviour and increased engagement with educational activities. Yet, routine treatment of ADHD in offenders is not yet established clinical practice. There is continued uncertainty about the clinical response to methylphenidate (MPH), a first-line treatment for ADHD, in offenders, who often present with an array of complex mental health problems that may be better explained by states of inattentive, overactive, restless and impulsive behaviours. To address this problem, we will conduct an efficacy trial to establish the short-term effects of osmotic-controlled release oral delivery system (OROS)-methylphenidate (Concerta XL), an extended release formulation of MPH, on ADHD symptoms, emotional dysregulation and behaviour.
Methods
This study is a parallel-arm, randomised, placebo-controlled trial of OROS-MPH on ADHD symptoms, behaviour and functional outcomes in young male prisoners aged 16â25, meeting Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria for ADHD. Participants are randomised to 8 weeks of treatment with OROS-MPH or placebo, titrated over 5âweeks to balance ADHD symptom improvement against side effects. Two hundred participants will be recruited with a 1:1 ratio of drug to placebo. The primary outcome is change in level of ADHD symptoms after 8 weeks of trial medication.
Discussion
Potential benefits include improvement in ADHD symptoms, emotional dysregulation, attitudes towards violence and critical incidents and increased engagement with educational and rehabilitation programmes. Demonstrating the efficacy and safety of MPH on ADHD symptoms and associated impairments may provide the data needed to develop effective healthcare pathways for a significant group of young offenders. Establishing efficacy of MPH in this population will provide the foundation needed to establish long-term effectiveness studies with the potential for demonstrating significant reductions in criminal behaviour and improved health-economic outcomes
Displaying emergency patient estimated wait times: A multi-centre, qualitative study of patient, community, paramedic and health administrator perspectives
Objective: EDs have the potential ability to predict patient wait times and to display this to patients and other stakeholders. Little is known about whether consumers and stakeholders would want this information and how wait time predictions might be used. The aim of the present study was to gain perspectives from consumers and health services personnel regarding the concept of emergency wait time visibility. Methods: We conducted a qualitative interview and focus group study in 2019. Participants included emergency medicine patients, families, paramedics, well community members, and hospital/paramedic administrators from multiple EDs and organisations in Victoria, Australia. Transcripts were coded and themes presented. Results: One focus group and 103 semi-structured interviews were conducted in 2019 including 32 patients, 22 carers/advocates and 21 paramedics in the ED; 20 health service administrators (paramedic and hospital) and 15 community members. Consumers and paramedics face physical and psychological difficulties when wait times are not visible. Consumers believe about a 2-h wait is tolerable, beyond this most begin to consider alternative strategies for seeking care. Consumers want to see triage to doctor times; paramedics want door-to-off stretcher times (for all possible transport destinations); with 47 of 50 consumers and 30 of 31 paramedics potentially using this information. About 28 of 50 consumers would use times to inform facility or provider choice, another 19 of 50 want information once in the waiting room. During prolonged waits, 51 of 52 consumers would continue to seek care. Conclusions: Consumers and paramedics want wait time information visibility. They would use the information in a variety of ways, both pre-hospital and while waiting for care