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 (23 838 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. CONCLUSIONS: 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. TRIAL REGISTRATION: ACTRN12615000607572 (pilot site); ACTRN12616000618459.

Professional Development Associate: Results of a National Survey.

Although many nursing professional development departments have an individual functioning in the professional development associate position, the role has never been formally described. To develop role clarity, a survey of 521 individuals was conducted to determine the extent of the role, responsibilities, and requirements of professional development associates. The survey indicates that standardization of titles, responsibilities, and competencies is needed. Strengthening the professional development associate role is vital to maintaining quality and efficiency and improving outcomes of professional development departments.

Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department.

Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician's efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor-patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p < 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics.

[Preferences of general practitioners in metropolitan France with regard to the delegation of medico-administrative tasks to secretaries assisting medico-social workers: Study in conjoint analysis]. / Préférences des médecins généralistes libéraux en France métropolitaine quant à la délégation des tâches médico-administratives aux secrétaires assistant(e)s médico-social(e)s : étude en analyse conjointe.

BACKGROUND: A general practitioner's office is an economic unit where task delegation is an essential component in improving the quality and performance of work. AIM: To classify the preferences of general practitioners regarding the delegation of medical-administrative tasks to assistant medical-social secretaries. METHOD: Conjoint analysis was applied to a random sample of 175 general practitioners working in metropolitan France. Ten scenarios were constructed based on seven attributes: training for medical secretaries, logistical support during the consultation, delegation of management planning, medical records, accounting, maintenance, and taking initiative on the telephone. A factorial design was used to reduce the number of scenarios. Physicians' socio-demographic variables were collected. RESULTS: One hundred and three physicians responded and the analysis included 90 respondents respecting the transitivity of preferences hypothesis. Perceived difficulty was scored 2.8 out of 5. The high rates of respondents (59%; 95% CI [51.7-66.3]) and transitivity (87.5%; 95% CI [81.1-93.9]) showed physicians' interest in this topic. Delegation of tasks concerning management planning (OR=2.91; 95% CI [2.40-13.52]) and medical records (OR=1.88; 95% CI [1.56-2.27]) were the two most important attributes for physicians. The only variable for which the choice of a secretary was not taken into account was logistical support. CONCLUSION: This is a first study examining the choices of general practitioners concerning the delegation of tasks to assistants. These findings are helpful to better understand the determinants of practitioners' choices in delegating certain tasks or not. They reveal doctors' desire to limit their ancillary tasks in order to favor better use of time for "medical" tasks. They also expose interest for training medical secretaries and widening their field of competence, suggesting the emergence of a new professional occupation that could be called "medical assistant".

Medical scribes have no impact on the patient experience of an emergency department.

OBJECTIVE: We aimed to evaluate patient perceptions of medical scribes in the ED and to test for scribe impacts on ED Net Promoter Scores, Press Ganey Surveys and other patient-centred topics. METHODS: Exploratory semi-structured interviews were conducted in the ED during wait times after scribed consultations. Interview results were used to derive topics relating to scribes. Items addressing these topics from validated surveys were combined with items from widely used patient satisfaction questionnaires. Questionnaires were administered in the ED by face-to-face approach while patients were waiting for admission/discharge or test results. Patients and doctors were blinded to the purpose of the questionnaire. The survey evaluated for non-inferiority of scribed consultations, using Net Promoter Scores, Press Ganey questions and questions specific to the presence of the scribe. RESULTS: Patient interviews did not identify any negative views regarding the presence of scribes during consultations. Thematic saturation was achieved after seven interviews. Two hundred and fifty-eight patients were approached to complete the questionnaire, and 215 participated (83%); 95 and 118 participants in the scribed and non-scribed groups, respectively. There was no difference between scribed and non-scribed consultations on the following measures of satisfaction: the Net Promoter Score, Press Ganey questions, quality of information received from doctors, communication, privacy concerns or inhibition about revealing private information and room crowding. CONCLUSION: We found no evidence that scribes reduce patient satisfaction during emergency consultations, nor prompt discomfort that might cause a patient to withhold information.

[Evaluation of the level of knowledge of medical secretaries about clinical specimens]. / Tibbi sekreterlerin klinik örnekler hakkindaki bilgi düzeylerinin belirlenmesi.

The rapid development of medical industry in the last 5 years in Turkey led to an increased demand for medical technicians and secretaries. The aim of this study was to evaluate the level of knowledge of students in Occupational School of Medical Documentation and Secretary about the clinical specimens, and to estimate the need for an additional education on clinical specimens. Four hundred and forty eight students from eight universities were participated to this questionnaire survey. Mean age of the participants were 20.4+/-1.66 years and 342 (76.3%) of them were female students. The mean answer rate of students to the questions about clinical specimens was found 3.4+/-1.9% (min-max: 0-10). Correct answer rates were similar for both first and second year students. There was a negative relationship between the educational year and the rate of correct answer, however the correlation was not significant. Additionally, internship period did not have any effect on the level of knowledge. The results of this survey have indicated that the level of knowledge of medical secretaries about clinical specimens was very low. As the roles and responsibilities of medical secretaries in medical industry increases, in order to increase the cost-effectivity, quality and patient satisfaction, the contents of their education programs must be reorganized, and a lecture about clinical specimens should be integrated.

Medical secretaries. Making the grade.

A review of the role of medical secretaries in a surgical directorate has reduced turnover among this group to zero. Previously the directorate had difficulty with recruitment and often had to rely on agency staff. The review led to the introduction of the new post of business coordinator, and all medical secretaries in the directorate have now achieved this level. The review led to an expanded role for medical secretaries which has increased their job satisfaction.

[Staff certification for mobile blood collection units]. / Une expérience de certification du personnel des prélèvements en collectes mobiles.

Training and official acknowledgment of the competence of each staff member are essential to the quality and safety of collected blood products prepared and delivered by a blood transfusion center. A procedure was created to indicate in detail the methods employed to implement such accreditation. Based on individual training according to activity, it defines for each type of activity (secretary, physician, collector, driver) the required theoretical and practical knowledge of his/her position. Accreditation, consisting of assessment of the degree of competence attained in these areas of responsibility, was applied to the members of mobile blood collection teams in 1995. No major deficiency was detected, and this certification was well accepted by the staff. In order to complete this initial accreditation, blood collection abnormalities (inadequate blood volumes, clots or defective welding of tubing) were assessed for each collector individually. Comparison of these abnormalities in qualified nurses and laboratory technicians with a blood collection diploma showed no differences. On the other hand, significantly higher numbers of abnormalities were found in intermittent as compared to regular collectors and in senior as compared to new collectors. The applied corrective measures led to obviation of differences and improvement in performance. In 1996, in the first individual evaluation of medical selection carried out by each physician, discrepancies of one to 20 donors (0.7-14.2%) were observed from one doctor to another in the frequency of elimination of candidates for blood donation after the medical interview. Regular meetings with physicians resulted in reducing these discrepancies to one to 3.1 donors (4.6-14.1%) in 1997. In conclusion, the association of an initial accreditation procedure with an individual follow-up of work quality allowed satisfactory assessment of the training and competence of staff members. This kind of method could be extended to those working in other fields of transfusion medicine.

Sistema regional administrativo financiero / sss

El presente manual tiene por objetivo planificar, programar y evaluar la ejecución financiera de las actividades en salud en todas las unidades ejecutoras de la red de servicios a partir de las necesidades de salud de la población, garantizando la oportuna transferencia de los recursos asignados y la correcta dotación y utilización de los bienes y servicios, en cada una de ellas a fin de contribuir a alcanzar los objetivos y metas del sector y brindar prestaciones en salud. Además presenta el reglamento para uso de vehículos de la Secretaria Regional de Salud Potosí. Instrumento para el manejo económico en administración financiera

Fortalecimiento de las acciones de lucha contra EDA/Cólera - Bolivia: financiamiento de ASDI-Suecia / sss

El presente proyecto es un plan nacional de lucha contra el cólera llevada en un seminario-taller; asistieron epidemiólogos de las diferentes Secretarias Regionales de Salud, además de la presencia de los miembros del Comíte Integral (USAID, OPS/OMS, UNICEF, CCH, CARE). El objetivo general del proyecto es la de disminuir la incidencia y letalidad por el EDA/Cólera en Bolivia

Fortalecimiento de las acciones de lucha contra EDA/Cólera - Bolivia: financiamiento de ASDI-Suecia / sss

El presente proyecto es un plan nacional de lucha contra el cólera llevada en un seminario-taller; asistieron epidemiólogos de las diferentes Secretarias Regionales de Salud, además de la presencia de los miembros del Comíte Integral (USAID, OPS/OMS, UNICEF, CCH, CARE). El objetivo general del proyecto es la de disminuir la incidencia y letalidad por el EDA/Cólera en Bolivia

An assessment of the value of video recordings of receptionists.

Video recordings of receptionists at work in general practice were found to be useful for self assessment by the receptionists and enabled the doctors to see areas for improvement in the organization of the reception area.

Base de datos del personal con item que trabaja en la Secretaria Nacional de Salud por municipio y niveles de atención / sss

El presente base de datos, ofrece información relevante para la primera linea de acción de la política de recursos humanos en el nuevo modelo Sanitario, tendiente a asignar el personal de atención primaria en función de población y necesidades. Fuentes de información: planilla matriz presupuestaria 1995 del Ministerio de Desarrollo Humano, Secretaria Nacional de Salud; sectores, áreas y distritos por municipio, secretarias regionales de: La Paz, Oruro, Cochabamba, Santa Cruz, Chuquisaca, Tarija, Beni, Riberalta, Pando, Potosí y Tupiza. El personal administrativo engloba tanto a nutricionistas, trabajadoras sociales, bioquímicos, personal administrativo, trabajadores manuales, etc.