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Trial registered on ANZCTR
Registration number
ACTRN12616000202460
Ethics application status
Approved
Date submitted
11/02/2016
Date registered
16/02/2016
Date last updated
12/10/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Physician attitudes towards, and experiences with the implementation of a scribe program in an Australian Emergency Department
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Scientific title
Physician attitudes towards, and experiences with the implementation of a scribe program in an Australian Emergency Department
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Secondary ID [1]
288225
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nil
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Universal Trial Number (UTN)
U1111-1177-9940
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Physician experience and attitudes to use of medical scribes
297143
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Physician productivity
297144
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Condition category
Condition code
Public Health
297369
297369
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0
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Health service research
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Survey of emergency physicians investigating their experiences of using medical scribes in Emergency Medicine consultations
(Scribe program being run in research capacity from October 2015 to September 2016, scribes training December to mid January, considered trained from mid-January onwards and utilised by physicians from mid January 2016 onwards (once trained)
(please see ACTRN12615000607572 - Walker, training and evaluating Australian scribes in Emergency Medicine and their impact on emergency physician productivity))
Measurement of the physician productivity (patients/hour) whilst allocated a medical scribe
Productivity analysis undertaken from January to September 2016
Interviews conducted with physicians. Conducted with independent interviewer. Two physicians who chose to decline the use of a scribe interviewed to determine their reasons for declining, and to identify any concerns that they have regarding the use of medical scribes.
Physicians who elected to work with medical scribes are interviewed to further identify their concerns and description of their experience using scribes. Interview questions are formulated based on themes reported in survey
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Intervention code [1]
293914
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Not applicable
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Comparator / control treatment
Productivity of same Emergency Physicians on non-scribed shifts (patients per hour)
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Control group
Active
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Outcomes
Primary outcome [1]
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Survey of physician attitudes, experiences and concerns - composite final outcome
The survey was designed specifically for this study
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Assessment method [1]
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Timepoint [1]
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Survey will be undertaken in April 2016
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Secondary outcome [1]
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Productivity data whilst using a scribe compared to not using a scribe
Patients per hour/Dr (on scribed vs unscribed shift)
this is assessed by accessing administrative databases collected during usual care:
*employee electronic timesheet database
*electronic medical record database
*billing databases
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Assessment method [1]
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Timepoint [1]
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Productivity data taken from January 14 2016 to September 30 2016
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Secondary outcome [2]
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Interviews held with Physicians - Outcome: questions asked to identify the experience and concerns held by Emergency Physicians regarding the use of medical scribes, and to identify the specific reasons why physicians would prefer not to work with a medical scribe
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Assessment method [2]
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Timepoint [2]
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December 2016 - following the end of the intervention period.
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Eligibility
Key inclusion criteria
Physicians with a Fellowship of the Australian College of Emergency Medicine (FACEM) working in the Emergency Department at Cabrini Hospital, Malvern who are enrolled in a clinical trial examining the relationship between Australian medical scribes and emergency physician productivity (ACTRN12615000607572) and who are allocated a scribe during the trial period
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Minimum age
30
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Physician exclusion criteria:
FACEMs unwilling to work with a scribe or unwilling to consent to the study (FACEMs unwilling to work with a scribe will be asked for consent to interview regarding their decision. They remain excluded from the survey component)
FACEMs working less than 1 shift per week
Scribe trainers
Primary investigator of the study
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Study design
Purpose
Psychosocial
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Duration
Cross-sectional
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
Qualitative analysis of similarities and differences between the responses to survey questions given by physicians to identify common themes
This is a pilot study only, there is no sample size calculation, simply a convenience sample of every eligible physician. It will be a descriptive observational analysis only identifying themes for future research.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/04/2016
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Actual
11/03/2016
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Date of last participant enrolment
Anticipated
8/04/2016
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Actual
2/05/2016
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Date of last data collection
Anticipated
17/12/2016
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Actual
1/11/2016
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Sample size
Target
15
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Accrual to date
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Final
13
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
4997
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Cabrini Hospital - Malvern - Malvern
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Recruitment postcode(s) [1]
12483
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3144 - Malvern
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Mr Timothy Cowan
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Address [1]
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Emergency Department
Cabrini
184 Wattletree Rd
malvern
VIC
3144
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Country [1]
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Australia
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Funding source category [2]
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Charities/Societies/Foundations
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Name [2]
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Equity Trustees on behalf of donors
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Address [2]
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Level 2, 575 Bourke St
Melbourne
Vic 3000
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Country [2]
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Australia
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Funding source category [3]
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Charities/Societies/Foundations
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Name [3]
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Cabrini Institute and Foundation
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Address [3]
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Emergency Department
Cabrini
154 Wattletree Rd
Malvern
3144
Vic
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Country [3]
292787
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Australia
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Primary sponsor type
Individual
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Name
Dr Katherine Walker
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Address
Emergency Department
Cabrini
184 Wattletree Rd
malvern
VIC
3144
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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na
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Address [1]
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na
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Country [1]
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Other collaborator category [1]
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Individual
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Name [1]
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William Dunlop
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Address [1]
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Emergency Department
Cabrini
183 Wattletree Rd
Malvern
3144
Vic
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Country [1]
278791
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Australia
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Other collaborator category [2]
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Individual
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Name [2]
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Katie Walker
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Address [2]
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Emergency Department
Cabrini
183 Wattletree Rd
Malvern
3144
Vic
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Country [2]
278792
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Australia
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Other collaborator category [3]
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Individual
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Name [3]
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Margaret Staples
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Address [3]
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Cabrini Institute
154 Wattletree Rd
Malvern
3144
Vic
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Country [3]
278793
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Australia
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Other collaborator category [4]
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Individual
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Name [4]
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Michael Ben-Meir
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Address [4]
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Emergency Department
Cabrini
183 Wattletree Rd
Malvern
3144
Vic
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Country [4]
278794
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Australia
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Other collaborator category [5]
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Individual
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Name [5]
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Eliza Gardner-Brunton
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Address [5]
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Emergency Department
Cabrini
183 Wattletree Rd
Malvern
3144
Vic
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Country [5]
278795
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Australia
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Other collaborator category [6]
279371
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Individual
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Name [6]
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Ainsley Treadwell
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Address [6]
279371
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Emergency Department Cabrini, 183 Wattletree Rd, Malvern, 3144 Vic
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Country [6]
279371
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
294266
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Cabrini Human Research Ethics Committee
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Ethics committee address [1]
294266
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154 Wattletree Road Malvern VIC 3144
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Ethics committee country [1]
294266
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Australia
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Date submitted for ethics approval [1]
294266
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01/02/2016
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Approval date [1]
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24/02/2016
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Ethics approval number [1]
294266
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CHREC 06-21-03-16
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Summary
Brief summary
Currently, Emergency Physicians in Australia perform a significant amount of clerical tasks in the provision of direct patient care. These clerical tasks may take up to 44% of the time dedicated to an individual patient and include the writing of notes, obtaining results, faxing and organising investigations, contacting other healthcare providers and billing. More broadly, the aging population and increasing use of the healthcare system in Australia, coupled with restrictions on the funding of healthcare is mounting pressure on emergency departments to make productivity gains and ensure their economic sustainability. Currently, physicians in the Cabrini Emergency department see 1.0 patients per hour on average however 2-3 patients per hour are seen with the assistance of medical scribes in other health systems (1,2). This gain in productivity forms an economic basis for the use of scribes in emergency departments, but the implementation of a scribe program can be a daunting experience to the physicians they work with. For a physician to work well with a scribe and improve their productivity they need to work differently, working in a team with their scribe, trusting the scribe’s work; letting go of administrative tasks and focusing on higher-level cognitive tasks for the majority of their time. This probably requires a good working relationship with their scribe and a positive experience of using a scribe. Physician experience with scribes is not yet broadly described, however Hess notes that 60% of their providers liked or really liked having a scribe whilst 9% would be happier if they weren’t allocated a scribe. Initial work at Cabrini describes marked differences in productivity gains between providers. There is no work published to date on the experiences of emergency physicians who like or don’t like having scribes and how this relates to the economics gains (or not), of the providers. Work is required to identify what a provider experiences when working with a scribe. What issues are anticipated before working with a scribe? Are these issues real issues as they work scribed shifts? Are there common themes of concerns about scribe utilisation? Can these barriers or concerns be described so that solutions can be considered? How do these concerns relate to productivity gains for each provider? This study aims to investigate the common concerns faced by physicians during the implementation of a scribe program and to compare these to the concerns held once the program is established. This study also aims to correlate the concerns regarding perceived productivity with actual productivity data. References 1. Arya R, Salovich DM, Ohman-Strickland P, Merlin MA. Impact of scribes on performance indicators in the emergency department. Acad. Emerg. Med. 2010; 17: 490–4. 2. ACEP use of scribes in the emergency department – an information paper. June 2011. [Cited 24 Jan 2016.] Available from URL: http://www.ACEP.org
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Trial website
none
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Trial related presentations / publications
Presentation: Cowan T, Dunlop W, Ben-Meir M, Staples M, Treadwell A, Gardner-Brunton E, Walker K (2016) Emergency consultants value medical scribes and most prefer to work with them, a few would rather not: a qualitative Australian study. ACEM ASM 2016 Queenstown NZ Publication: Cowan TL, Dunlop WA, Ben-Meir M, et al Emergency consultants value medical scribes and most prefer to work with them, a few would rather not: a qualitative Australian study Emerg Med J Published Online First: 29 September 2017. doi: 10.1136/emermed-2017-206637
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Public notes
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Contacts
Principal investigator
Name
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Mr Timothy Cowan
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Address
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Emergency Department
Cabrini
184 Wattletree Rd
Malvern
Vic
3144
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Country
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Australia
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Phone
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+61407622694
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Katie Walker
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Address
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Emergency Department
Cabrini
184 Wattletree Rd
Malvern
Vic
3144
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Country
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Australia
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Phone
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+61431272262
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
62428
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Katie Walker
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Address
62428
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Emergency Department
Cabrini
184 Wattletree Rd
Malvern
Vic
3144
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Country
62428
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Australia
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Phone
62428
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+613 9508 1500
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Fax
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Email
62428
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF