Evaluating an implementation of the Australian National Guidelines for the On-Screen Display of Discharge Summaries.

Objective The objective of this study was to evaluate changes in the inclusion of pertinent information on electronic discharge summaries (eDS) after implementation of a revised template and electronic medical record (EMR) workflow. Methods A retrospective medical record audit of eDS at three metropolitan hospitals was undertaken for adult inpatient encounters in June 2021 (pre-intervention, n = 100) and June 2022 (post-intervention, n = 100). The eDS were evaluated against 16 components listed in the Australian National Guidelines for the On-Screen Display of Discharge Summaries. Nine components were further broken down to between two and 11 sub-components. Sub-analysis compared a hospital with full EMR to pooled results from hospitals with hybrid EMRs. Components and sub-components were evaluated for inclusion only; accuracy or relevance of the information was not assessed. Results Inclusion of three out of 16 components (presentation details: 47% vs 62%, problems and diagnosis: 61% vs 86% and recipient details: 82% vs 93%) and eight out of 36 sub-components (discharge destination, principal diagnosis, history of presenting complaint, infection risk, pressure injury, screening and/or diagnosis of delirium and GP phone number and address) was higher in the post-intervention group (all P < 0.05). Reduced eDS information inclusion in the post-intervention group was observed for discharge date and falls risk only (both P < 0.05). Reporting of falls history decreased at the hospital with full EMR (71% vs 20% P < 0.001) but not at hospitals utilising hybrid EMRs (24% vs 30% P = 0.5). Conclusion The intervention was associated with improved inclusion of pertinent information as described in the Australian National Guidelines for the On-Screen Display of Discharge Summaries.

Feasibility evaluation of a pilot scribe-training program in an Australian emergency department.

Objective Medical scribes have an emerging and expanding role in health, particularly in Emergency Medicine in the US. Scribes assist physicians with documentation and clerical tasks at the bedside while the physician consults with his or her patient. Scribes increase medical productivity. The aim of the present study was to examine the feasibility of a pilot hospital-administered scribe-training program in Australia and to evaluate the ability of an American training course (Medical Scribe Training Systems) to prepare trainee scribes for clinical training in an emergency department in Australia. Methods The present study was a pilot, prospective, observational cohort study from September 2015 to February 2016 at Cabrini Emergency Department, Melbourne. Scribe trainees were enrolled in the pre-work course and then trained clinically. Feasibility of training scribes and limited efficacy testing of the course was undertaken. Results The course was acceptable to users and demand for training exists. There were many implementation tasks and issues experienced and resources were required to prepare the site for scribe implementation. Ten trainees were enrolled for preclinical training. Six candidates undertook clinical training, five achieved competency (required seven to 16 clinical shifts after the preclinical course). The training course was helpful and provided a good introduction to the scribe role. The course required adaptation to a non-US setting and the specific hospital setting. In addition, it needed more detail in some common emergency department topics. Conclusion Training scribes at a hospital in Australia is feasible. The US training course used can assist with preclinical training. Course modification is required. What is known about the topic? Scribes increase emergency physician productivity in Australia. There is no previous work on how to train scribes in Australia. What does this paper add? We show that implementing a scribe-training program is feasible and that a training package can be purchased from the US to train scribes in Australia and that it is useful. We also show the adaptation that the course may require to meet Australian emergency department needs. What are the implications for practitioners? Scribes could become an additional member of the emergency department team in Australia and can be trained locally.

The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine.

BACKGROUND: Scribes are assisting Emergency Physicians by writing their electronic clinical notes at the bedside during consultations. They increase physician productivity and improve their working conditions. The quality of Emergency scribe notes is unevaluated and important to determine. OBJECTIVE: The primary objective of the study was to determine if the quality of Emergency Department scribe notes was equivalent to physician only notes, using the Physician Documentation Quality Instrument, Nine-item tool (PDQI-9). METHODS: This was a retrospective, observational study comparing 110 scribed to 110 non-scribed Emergency Physician notes written at Cabrini Emergency Department, Australia. Consultations during a randomised controlled trial of scribe/doctor productivity in 2016 were used. Emergency physicians and nurses rated randomly selected, blinded and de-identified notes, 2 raters per note. Comparisons were made between paired scribed and unscribed notes and between raters of each note. Characteristics of individual raters were examined. The ability of the tool to discriminate between good and poor notes was tested. RESULTS: The PDQI-9 tool has significant issues. Individual items had good internal consistency (Cronbach's alpha=0.93), but there was very poor agreement between raters (Pearson's r=0.07, p=0.270). There were substantial differences in PDQI-9 scores allocated by each rater, with some giving typically lower scores than others, F(25,206)=1.93, p=0.007. The tool was unable to distinguish good from poor notes, F(3,34)=1.15, p=0.342. There was no difference in PDQI-9 score between scribed and non-scribed notes. CONCLUSIONS: The PDQI-9 documentation quality tool did not demonstrate reliability or validity in evaluating Emergency Medicine consultation notes. We found no evidence that scribed notes were of poorer quality than non-scribed notes, however Emergency scribe note quality has not yet been determined.

An economic evaluation of the costs of training a medical scribe to work in Emergency Medicine.

OBJECTIVE: To undertake a cost analysis of training medical scribes in an ED. METHODS: This was a pilot, observational, single-centre study at Cabrini ED, Melbourne, Australia, studying the costs of initiating a scribe programme from the perspective of the hospital and Australian Health sector. Recruitment and training occurred between August 2015 and February 2016 and comprised of a prework course (1 month), prework training sessions and clinical training shifts for scribe trainees (2-4 months, one shift per week) who were trained by emergency physicians. Costs of start-up, recruitment, administration, preclinical training, clinical training shifts and productivity changes for trainers were calculated. RESULTS: 10 trainees were recruited to the prework course, 9 finished, 6 were offered clinical training after simulation assessment, 5 achieved competency. Scribes required clinical training ranging from 68 to 118 hours to become competent after initial classroom training. Medical students (2) required 7 shifts to become competent, premedical students (3) 8-16 shifts, while a trainee from an alternative background did not achieve competency. Based on a scribe salary of US$15.91/hour (including 25% on-costs) plus shift loadings, costs were: recruitment and start-up US$3111, education US$1257, administration US$866 and clinical shift costs US$1137 (overall cost US$6317 per competent scribe). Physicians who trained the clinical trainee scribes during shifts did not lose productivity. CONCLUSIONS: Training scribes outside the USA is feasible using an on-line training course and local physicians. It makes economic sense to hire individuals who can work over a long period of time to recoup training costs. TRIAL REGISTRATION NUMBER: ACTRN12615000607572.

Impact of pain location, organ system and treating speciality on timely delivery of analgesia in emergency departments.

OBJECTIVE: This retrospective, observational cohort study investigated whether the clinical features of a patient's pain, including anatomical location, organ system and likely treating speciality, impact on the delivery of analgesia within 30 min in EDs. METHODS: Data were obtained from 24 centres across Australia between April 2008 and March 2009. Principal outcome was delivery of analgesia within 30 min or less. Factors that might explain any differences were analysed, including anatomical location of the pain, likely treating speciality, organ system affected, age, sex, day and time of presentation, hospital location, documented pain score and triage category. Analysis was by the χ(2)-test for independence of proportions and multiple logistic regression. A P-value <0.05 was considered statistically significant. RESULTS: There were 4598 patients, of whom 2578 were male. The median age was 36 years (range 0-103). Both limb origin of pain (χ(2) = 46.1, P < 0.001) and documentation of a pain score (χ(2) = 48.6, P < 0.001) were strongly associated with delivery of analgesia within 30 min. Attending a rural ED was a significant risk factor for delayed analgesia (χ(2) = 12.5, P < 0.001). Burns patients (40.2%, 47 of 117, P < 0.001) and orthopaedic patients (26.1%, 259 of 992, P < 0.001) were much more likely to received analgesia within 30 min than the mean (19.5%, 896 of 4598). CONCLUSIONS: Patients presenting with burns, orthopaedic conditions or with a limb location of pain are more likely to receive analgesia within 30 min in Australian EDs. Clinicians should be aware of possible trends in the delivery of timely analgesia to patients with pain.