Implementation of Scribes in an Academic Emergency Department: The Resident Perspective.

BACKGROUND: Medical scribes have been shown to improve emergency department (ED) throughput, physician productivity metrics, and patient satisfaction by fulfilling primary documentation and nonclinical functions. Little research has been done to date to study the effect of implementing a scribe program in a residency setting. OBJECTIVE: Our goal was to investigate emergency medicine residents' perception of their educational experience, including interactions with faculty, before and after the implementation of an ED scribe program. METHODS: We used a pre-post design to assess residents' perceptions of their educational experience before and after implementation of the scribe program. Residents at a large, urban academic medical center with an Accreditation Council for Graduate Medical Education-accredited, 4-year emergency medicine residency program were surveyed during August 2015 (prior to the implementation of the scribe program) and April 2016 (6 months after implementation). RESULTS: Residents reported improved educational experiences with statistically significant changes in the following areas: increased interaction with faculty due to fewer documentation requirements (P = .012); more face-to-face teaching with faculty (P < .001); increased faculty supervision for procedures (P = .016); and a decrease of delays in patient disposition due to incomplete documentation (P = .029). CONCLUSIONS: Implementation of an ED scribe program in an urban 4-year emergency medicine residency program led to improvements in residents' perceptions of their education.

Prognostic value of post-Yttrium 90 radioembolization therapy 18F-fluorodeoxyglucose positron emission tomography in patients with liver tumors.

OBJECTIVE: This study assessed the benefit of post-therapy 18F-FDG PET/CT versus CT alone in identifying malignant liver tumor progression following radioembolization with Y-90 microspheres. METHODS: 24 patients with 44 liver tumors underwent CT imaging pre-radioembolization and PET/CT post-radioembolization. Predictive value of Response Evaluation Criteria in Solid Tumors (RECIST 1.1), The World Health Organization (WHO), mRECIST and European Association for the Study of the Liver (EASL) with PET/CT versus CT alone was assessed. RESULTS: Prediction of liver malignancy progression was improved (p<0.05) for tumors labeled as non-responding based on combined PET/CT with RECIST 1.1, WHO, mRECIST, and EASL criteria compared to assessment without PET. CONCLUSIONS: The addition of post-therapy PET to routine CT in patients with hepatic tumors undergoing radioembolization may improve identification of non-responding tumors.