Study objective: Documentation in the medical record increases clerical burden to clinicians and reduces time available to spend with patients, thereby leading to less efficient care and increased clinician stress. Scribes have been proposed as one approach to reduce this burden on clinicians and improve efficiency. The primary objective of this study is to assess the effect of scribes on throughput, revenue, provider satisfaction, and patient satisfaction in both the emergency department (ED) and non-ED setting.Methods: PubMed, Scopus, the Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature database, Google Scholar, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched for studies assessing the effect of scribes versus no scribes on the following outcomes: patients per hour, relative value units (RVUs) per hour, RVUs per encounter, clinic length of stay, time to disposition, ED length of stay, ED length of stay for admitted patients, ED length of stay for discharged patients, provider satisfaction, and patient satisfaction. Data were dual extracted into a predefined work sheet, and quality analysis was performed with the Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Subgroup analyses were planned between ED versus non-ED studies. Results:We identified 39 studies comprising greater than 562,682 patient encounters. Scribes increased patients treated per hour by 0.30 (95% confidence interval [CI] 0.10 to 0.51). Scribes increased RVUs per encounter by 0.14 (95% CI 0.03 to 0.24) and RVUs per hour by 0.55 (0.30 to 0.80). There was no difference in time to disposition (5.74 minutes; 95% CI -2.63 to 14.10 minutes) or ED length of stay (-3.44 minutes; 95% CI -7.68 to 0.81 minutes), although a difference was found in clinic length of stay (5.74 minutes; 95% CI 0.42 to 11.05 minutes). Fourteen of 16 studies reported favorable provider satisfaction with a scribe. Seven of 18 studies reported favorable patient satisfaction with a scribe. No studies reported negative provider or patient satisfaction with scribes. Conclusion:Overall, we found that scribes improved RVUs per hour, RVUs per encounter, patients per hour, provider satisfaction, and patient satisfaction. However, we did not identify an improvement in ED length of stay. Future studies are needed to determine the cost-benefit effect of scribes and ED volume necessary to support their use. [
COVID-19 vaccination hesitancy among healthcare personnel in the emergency department deserves continued attention With nearly 100M reported infections and over 2M deaths, the COVID-19 pandemic has evolved into a generational medical crisis. Efforts to enact mitigating behaviors (e.g. mask wearing, social distancing) occurred simultaneous to worldwide endeavors at vaccine development. This culminated on December 8th, 2020, when the United Kingdom administered the first therapeutic dose of the Pfizer COVID-19 Vaccine [1]. While viewed as a massive medical achievement by worldwide governments and healthcare organizations alike, there is evidence the public remains skeptical of these novel and rapidly developed COVID-19 vaccines.As recently as November 2020, only 29% of surveyed American responded they would "definitely" get the COVID-19 vaccine if made available [2]. Factors that may be negatively impacting vaccine acceptance include type of FDA approval (full vs. emergency use authorization) and foreign manufacturing origin [3]. Health Care Personnel (HCP) were not immune to uncertainty, with survey data from over 12,000 nurses reporting that 37% of respondents were "not confident" that the COVID-19 Vaccine was "safe and effective" [4]. Another study of HCP preliminarily reports 36% of respondents were willing to take the vaccine as soon as it was available, but 56% electing to wait for more vaccine safety data [5]. While there are some studies looking at vaccine acceptance "if available," there is limited data on vaccine acceptance with vaccine "now available." Phase 1a of vaccine distribution began the week of December 14th, and according to the CDC/NIH-commissioned study, there are 24 million Americans in all of Phase 1, including 21 million HCP and 3million residents of long-term care facilities (LTCFs) [6]. On December 17th, 2020, our healthcare system began administering initial vaccinations. A working group developed a survey using closed format and open format answer responses, with the aim to understand attitudes and characteristics of HCP in an Emergency Department (ED) who have been offered COVID-19 Vaccination. The survey was piloted for study performance and revised and distributed to HCP working in the emergency department from January 11th, 2021 to January 23rd , 2021 . Responses were anonymous and voluntary. Descriptive analysis was performed.The survey was sent to 398 HCPs who work in the ED at our large urban public hospital with an ED census of 130,000 per year with a response rate of 61% overall. 92% of respondents reported they received the vaccine or are scheduled to and 8% reported they will not be getting the vaccine. Median age range of the 240 HCP respondents was 41-50 years old, 136 (57%) were women, 99 (41%) were White, 57 (24%) were Black and 30 (13%) were Latinx. Response rate based on job category varied ranging from 31% to 100%. The largest categories
IntroductionThe effect of nurse staffing on emergency department (ED) efficiency remains a significant area of interest to administrators, physicians, and nurses. We believe that decreased nursing staffing adversely affects key ED throughput metrics.MethodsWe conducted a retrospective observational review of our electronic medical record database from 1/1/2015 to 12/31/2015 at a high-volume, urban public hospital. We report nursing hours, door-to-discharge length of stay (LOS) and door-to-admit LOS, and percentage of patients who left without being seen (LWBS). ED nursing hours per day was examined across quartiles with the effect evaluated using analysis of covariance and controlled for total daily ED volume, hospital occupancy and ED admission rate.ResultsFrom 1/1/15–12/31/15, 105,887 patients presented to the ED with a range of 336 to 580 nursing hours per day with a median of 464.7. Independent of daily ED volume, hospital occupancy and ED admission rate, days in the lowest quartile of nursing hours experienced a 28.2-minute increase per patient in door-to-discharge LOS compared to days in the highest quartile of nursing hours. Door-to-admit LOS showed no significant change across quartiles. There was also an increase of nine patients per day who left without being seen by a provider in the lowest quartile of nursing hours compared to the highest quartile.ConclusionLower nursing hours contribute to a statistically significant increase in door-to-discharge LOS and number of LWBS patients, independent of daily ED volume, hospital occupancy and ED admission rate. Consideration of the impact of nursing staffing is needed to optimize throughput metrics for our urban, safety-net hospital.
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