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.

Re-Emergence of Zika Virus: A Review on Pathogenesis, Clinical Manifestations, Diagnosis, Treatment, and Prevention.

Zika virus (ZKV) is an arbovirus of the Flaviviridae family, which includes West Nile, dengue fever, yellow fever, and Japanese encephalitis virus. It is transmitted by the Aedes genus of mosquitoes. Before 2015, ZKV outbreaks occurred in areas of Africa, the Pacific Islands, and Southeast Asia. The current large outbreak, which began in Brazil, has also emerged throughout a large part of South/Central America, a number of islands in the Caribbean, including Puerto Rico, the Virgin Islands, and Mexico. A sudden rise in the numbers of infants reported born with microcephaly in Brazil, and the detection of the single-stranded positive RNA virus in the amniotic fluid of affected newborns, has captured medical, mainstream media, and global political attention, causing considerable concern in a post-Ebola global community considerably more focused on the threat of internationally transmissible diseases. The goal of this article is to provide an overview of ZKV for clinicians, with the emphasis on pathogenesis, clinical manifestations, diagnosis, and treatment/preventive measures.

Exploratory analysis of patients' motivations to quit smoking and participate in smoking cessation classes.

BACKGROUND AND OBJECTIVES: Significant research has evaluated the impacts of smoking, the impacts of exposure to secondhand smoke, the effectiveness of a variety of social and individual interventions for smoking cessation, and the frequency at which physicians discuss smoking cessation with their patients. Little research has addressed barriers to physician-initiated discussion and intervention related to smoking cessation, especially pertaining to resident physicians treating low-income patients. The existing research indicates that physicians have low expectations regarding patients' desires to quit smoking and often wait to discuss smoking cessation with patients until the patient broaches the subject. The purpose of this pilot was to identify trends in smoking, desire for smoking cessation, and desire to participate in smoking cessation classes at the family practice clinic. METHODS: Patients completed a survey eliciting demographic information, smoking behavior, presence of chronic illness, desire to quit smoking, and reasons for wanting to quit smoking. RESULTS: Higher rates of smoking and lower rates of desired cessation were identified. However, among patients contemplating smoking cessation, a relatively high number desired cessation classes. Higher numbers of failed quit attempts were predictive of increases odds of both wanting to quit and desire for cessation classes. Other predictors of cessation desire and class participation are discussed. CONCLUSIONS: Based on the current research, physicians are encouraged to follow practice guidelines, asking all patients about smoking behavior and assisting in their efforts to quit, especially those who have previously been unsuccessful in the past.