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

2018 ◽  
Vol 42 (2) ◽  
pp. 210 ◽  
Author(s):  
Katherine Walker ◽  
Matthew Johnson ◽  
William Dunlop ◽  
Margaret Staples ◽  
Hamish Rodda ◽  
...  
Keyword(s):  
Emergency Department ◽  
Training Program ◽  
Clinical Training ◽  
Hospital Setting ◽  
Training Course ◽  
The Us ◽  
Feasibility Evaluation ◽  
Observational Cohort ◽  
Medical Scribes ◽  
Preclinical Training

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.

scholarly journals Safe use of the EHR by medical scribes: a qualitative study

2020 ◽  
Author(s):  
Joan S Ash ◽  
Sky Corby ◽  
Vishnu Mohan ◽  
Nicholas Solberg ◽  
James Becton ◽  
...  
Keyword(s):  
Patient Safety ◽  
Best Practices ◽  
Clinical Training ◽  
Rapid Assessment ◽  
Data Gathering ◽  
Assessment Process ◽  
Healthcare Organizations ◽  
Safety Risks ◽  
The Us ◽  
Medical Scribes

Abstract Objective Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk. Materials and Methods Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach. Results We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the “technical” dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The “environmental” dimension included the changing scribe industry and need for standards. Within the “personal” dimension, themes included the need for provider diligence and training when using scribes. Finally, the “organizational” dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety. Conclusion Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.

scholarly journals Comprehensive residency-based point-of-care ultrasound training program increases ultrasound utilization in the emergency department

2020 ◽  
Author(s):  
Wei-Lung Chen ◽  
Chan-Peng Hsu ◽  
Po-Han Wu ◽  
Jiann-Hwa Chen ◽  
Chien-Cheng Huang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Training Program ◽  
Test Score ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Ultrasound Studies ◽  
Training Course ◽  
Hemodynamic Assessment ◽  
Procedural Guidance

Abstract Background: Point-of-care ultrasonography (POCUS) is a prompt and simple tool for the urgent diagnosis and treatment of patients in the emergency department (ED). It has contributed to improvements in patient treatment quality, procedural safety, timeliness of care, diagnostic accuracy, and cost reduction. We developed a comprehensive residency-based POCUS training program for ED residents and determined its effect on ultrasound utilization in the ED.Methods: We conducted a retrospective cohort study in the ED of a university-affiliated medical center, evaluating a centralized residency-based POCUS training course from July 2017 to June 2018 for ED residents that included 12 core ultrasound applications: trauma, intrauterine pregnancy, abdominal aortic aneurysm, echocardiography and hemodynamic assessment, hepatobiliary system, urinary tract, deep vein thrombosis, soft tissue and musculoskeletal, thoracic-airway, ocular, bowel, and procedural guidance. Each application comprised a combined lecture and hands-on practice session that lasted for 2 hours. Pre-tests and post-tests, including still image and video interpretation, were performed. Utilization of POCUS among ED residents before and after the POCUS training course (July 2016–June 2017 and July 2018–June 2019) was calculated and analyzed using the Wilcoxon signed-rank test.Results: In total, 16 residents participated and completed the entire training course. The post-test score improved significantly compared to the pre-test score by a median of 12 points (p = 0.04). Utilization of POCUS among the ED residents increased significantly from 0.15 ultrasound studies per patient per year to 0.41 ultrasound studies per patient per year (p < 0.01) after completion of the entire training course. Increased POCUS scanning percentages over the cardiac, soft tissue, abdominal region, vascular system, procedural guidance, and ocular regions were also noted after providing the curriculum.Conclusions: There was a significant increase in POCUS utilization among ED residents after a comprehensive residency-based POCUS training program.

scholarly journals Idle peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices

2020 ◽  
Author(s):  
Hugo Evison ◽  
Amy Sweeny ◽  
Jamie Ranse ◽  
Mercedes Carrington ◽  
Nicole Marsh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Setting ◽  
Observational Cohort Study ◽  
Hospital Environment ◽  
Emergency Setting ◽  
Observational Cohort ◽  
Using Data ◽  
Intravenous Catheters ◽  
Hospital Group

Abstract Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February - 18 March 2017 and 5 January - 4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression.Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%-31.9%) remained idle at 24h. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs 7.4%). Nursing staff inserted idle PIVC at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC insertion in the ED was the only factor significantly (p=<.001) predicting an idle outcome (Odds Ratio: 2.4; 95%CI 1.7-3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of ante-cubital insertion. Reasons for these differences are not well understood and requires more targeted research.

scholarly journals Evaluation and Effectiveness of a Two-Day Dementia Training Program for Hospital Staff Working in an Emergency Department

2021 ◽  
pp. 1-14
Author(s):  
Julia Schneider ◽  
Jennifer Miller ◽  
Winfried Teschauer ◽  
Andreas Kruse ◽  
Birgit Teichmann
Keyword(s):  
Emergency Department ◽  
Organizational Performance ◽  
Training Program ◽  
Qualitative Content Analysis ◽  
Hospital Setting ◽  
Hospital Staff ◽  
Individual Performance ◽  
Working Environment ◽  
Structured Interviews ◽  
People With Dementia

Background: Entering the hospital via an emergency department (ED) is a pivotal moment in the life of people with dementia (PwD) and often starts an avoidable downward spiral. Therefore, it is required to further educate ED staff to raise awareness of the needs of PwD. Although there are many studies about existing dementia training programs for the hospital setting, empirical evidence for the ED setting and cross-level training evaluations are lacking. Objective: The study aims to evaluate a two-day dementia training course for ED staff on the outcome levels of learning, individual performance, and organizational performance. Furthermore, the study examines whether the training fulfilled participants’ expectations. Methods: Mixed methods were used to assess data from head nurses, nursing, and administrative staff working in EDs. We conducted semi-structured interviews three weeks before (N = 18) and eight months after (N = 9) the training. Questionnaire data were assessed before the training, three months, and six months after the training (N = 44). A qualitative content analysis was conducted to analyze qualitative data; quantitative data was described descriptively. Results: The intervention seems to be effective on both learning and individual performance levels. However, we did not observe any changes in the organizational performance. The training program met attendees’ expectations only partly. The working environment of EDs needs to be taken more into account. Conclusion: Hospital staffs’ expectations of a dementia training program depend on the work area in which they operate. Results support the implementation of intervention bundles to enable sustainable cross-level changes.

scholarly journals Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Hugo Evison ◽  
Amy Sweeny ◽  
Jamie Ranse ◽  
Mercedes Carrington ◽  
Nicole Marsh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Setting ◽  
Observational Cohort Study ◽  
Hospital Environment ◽  
Emergency Setting ◽  
Observational Cohort ◽  
Using Data ◽  
Intravenous Catheters ◽  
Hospital Group

Abstract Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

Interprofessional Collaboration to Promote Culturally Engaged and Strengths-Based Practice

2020 ◽  
Vol 5 (6) ◽  
pp. 1410-1421
Author(s):  
Erica Ellis ◽  
Mary Kubalanza ◽  
Gabriela Simon-Cereijido ◽  
Ashley Munger ◽  
Allison Sidle Fuligni
Keyword(s):  
Los Angeles ◽  
Training Program ◽  
Interprofessional Education ◽  
Clinical Training ◽  
Interprofessional Collaboration ◽  
Communication Disorders ◽  
Outreach Program ◽  
State University ◽  
Diversity And Inclusion ◽  
Health Nursing

Purpose To effectively prepare students to engage in interprofessional practice, a number of Communication Disorders (COMD) programs are designing new courses and creating additional opportunities to develop the interprofessional competencies that will support future student success in health and education-related fields. The ECHO (Educational Community Health Outreach) program is one example of how the Rongxiang Xu College of Health and Human Services at California State University, Los Angeles, has begun to create these opportunities. The ultimate goal of the ECHO project is to increase both access to and continuity of oral health care across communities in the greater Los Angeles area. Method We describe this innovative interdisciplinary training program within the context of current interprofessional education models. First, we describe the program and its development. Second, we describe how COMD students benefit from the training program. Third, we examine how students from other disciplines experience benefits related to interprofessional education and COMD. Fourth, we provide reflections and insights from COMD faculty who participated in the project. Conclusions The ECHO program has great potential for continuing to build innovative clinical training opportunities for students with the inclusion of Child and Family Studies, Public Health, Nursing, and Nutrition departments. These partnerships push beyond the norm of disciplines often used in collaborative efforts in Communication Sciences and Disorders. Additionally, the training students received with ECHO incorporates not only interprofessional education but also relevant and important aspects of diversity and inclusion, as well as strengths-based practices.

scholarly journals External validation of an opioid misuse machine learning classifier in hospitalized adult patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Majid Afshar ◽  
Brihat Sharma ◽  
Sameer Bhalla ◽  
Hale M. Thompson ◽  
Dmitriy Dligach ◽  
...  
Keyword(s):  
Machine Learning ◽  
Screening Program ◽  
External Validation ◽  
Hospital Setting ◽  
Opioid Misuse ◽  
Original Cohort ◽  
Learning Classifier ◽  
Observational Cohort ◽  
Drug Abuse Screening Test ◽  
Screening Barriers

Abstract Background Opioid misuse screening in hospitals is resource-intensive and rarely done. Many hospitalized patients are never offered opioid treatment. An automated approach leveraging routinely captured electronic health record (EHR) data may be easier for hospitals to institute. We previously derived and internally validated an opioid classifier in a separate hospital setting. The aim is to externally validate our previously published and open-source machine-learning classifier at a different hospital for identifying cases of opioid misuse. Methods An observational cohort of 56,227 adult hospitalizations was examined between October 2017 and December 2019 during a hospital-wide substance use screening program with manual screening. Manually completed Drug Abuse Screening Test served as the reference standard to validate a convolutional neural network (CNN) classifier with coded word embedding features from the clinical notes of the EHR. The opioid classifier utilized all notes in the EHR and sensitivity analysis was also performed on the first 24 h of notes. Calibration was performed to account for the lower prevalence than in the original cohort. Results Manual screening for substance misuse was completed in 67.8% (n = 56,227) with 1.1% (n = 628) identified with opioid misuse. The data for external validation included 2,482,900 notes with 67,969 unique clinical concept features. The opioid classifier had an AUC of 0.99 (95% CI 0.99–0.99) across the encounter and 0.98 (95% CI 0.98–0.99) using only the first 24 h of notes. In the calibrated classifier, the sensitivity and positive predictive value were 0.81 (95% CI 0.77–0.84) and 0.72 (95% CI 0.68–0.75). For the first 24 h, they were 0.75 (95% CI 0.71–0.78) and 0.61 (95% CI 0.57–0.64). Conclusions Our opioid misuse classifier had good discrimination during external validation. Our model may provide a comprehensive and automated approach to opioid misuse identification that augments current workflows and overcomes manual screening barriers.

scholarly journals A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

2019 ◽  
Vol 21 (1) ◽  
pp. 149-151 ◽  
Author(s):  
Ashley Rider ◽  
Tiffany Anaebere ◽  
Mariko Nomura ◽  
David Duong ◽  
Charlotte Wills
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Interprofessional Education ◽  
Hospital Setting ◽  
Scope Of Practice ◽  
Registered Nursing ◽  
Interprofessional Training ◽  
Before And After ◽  
Team Based Care ◽  
Improve Health

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.

Sign in / Sign up

Export Citation Format

Share Document