Trial Review

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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
Scientific title
Physician attitudes towards, and experiences with the implementation of a scribe program in an Australian Emergency Department
Secondary ID [1] 288225 0
nil
Universal Trial Number (UTN)
U1111-1177-9940
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Physician experience and attitudes to use of medical scribes 297143 0
Physician productivity 297144 0
Condition category
Condition code
Public Health 297369 297369 0 0
Health service research

Intervention/exposure
Study type
Observational
Patient registry
False
Target follow-up duration
Target follow-up type
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
Intervention code [1] 293914 0
Not applicable
Comparator / control treatment
Productivity of same Emergency Physicians on non-scribed shifts (patients per hour)
Control group
Active

Outcomes
Primary outcome [1] 296924 0
Survey of physician attitudes, experiences and concerns - composite final outcome
The survey was designed specifically for this study
Timepoint [1] 296924 0
Survey will be undertaken in April 2016
Secondary outcome [1] 319711 0
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
Timepoint [1] 319711 0
Productivity data taken from January 14 2016 to September 30 2016
Secondary outcome [2] 330126 0
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
Timepoint [2] 330126 0
December 2016 - following the end of the intervention period.

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
Minimum age
30 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
Yes
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

Study design
Purpose
Psychosocial
Duration
Cross-sectional
Selection
Defined population
Timing
Prospective
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.

Recruitment
Recruitment status
Completed
Date of first participant enrolment
Anticipated
1/04/2016
Actual
11/03/2016
Date of last participant enrolment
Anticipated
8/04/2016
Actual
2/05/2016
Date of last data collection
Anticipated
17/12/2016
Actual
1/11/2016
Sample size
Target
15
Accrual to date
Final
13
Recruitment in Australia
Recruitment state(s)
VIC
Recruitment hospital [1] 4997 0
Cabrini Hospital - Malvern - Malvern
Recruitment postcode(s) [1] 12483 0
3144 - Malvern

Funding & Sponsors
Funding source category [1] 292639 0
Self funded/Unfunded
Name [1] 292639 0
Mr Timothy Cowan
Country [1] 292639 0
Australia
Funding source category [2] 292786 0
Charities/Societies/Foundations
Name [2] 292786 0
Equity Trustees on behalf of donors
Country [2] 292786 0
Australia
Funding source category [3] 292787 0
Charities/Societies/Foundations
Name [3] 292787 0
Cabrini Institute and Foundation
Country [3] 292787 0
Australia
Primary sponsor type
Individual
Name
Dr Katherine Walker
Address
Emergency Department
Cabrini
184 Wattletree Rd
malvern
VIC
3144
Country
Australia
Secondary sponsor category [1] 291355 0
None
Name [1] 291355 0
na
Address [1] 291355 0
na
Country [1] 291355 0
Other collaborator category [1] 278791 0
Individual
Name [1] 278791 0
William Dunlop
Address [1] 278791 0
Emergency Department
Cabrini
183 Wattletree Rd
Malvern
3144
Vic
Country [1] 278791 0
Australia
Other collaborator category [2] 278792 0
Individual
Name [2] 278792 0
Katie Walker
Address [2] 278792 0
Emergency Department
Cabrini
183 Wattletree Rd
Malvern
3144
Vic
Country [2] 278792 0
Australia
Other collaborator category [3] 278793 0
Individual
Name [3] 278793 0
Margaret Staples
Address [3] 278793 0
Cabrini Institute
154 Wattletree Rd
Malvern
3144
Vic
Country [3] 278793 0
Australia
Other collaborator category [4] 278794 0
Individual
Name [4] 278794 0
Michael Ben-Meir
Address [4] 278794 0
Emergency Department
Cabrini
183 Wattletree Rd
Malvern
3144
Vic
Country [4] 278794 0
Australia
Other collaborator category [5] 278795 0
Individual
Name [5] 278795 0
Eliza Gardner-Brunton
Address [5] 278795 0
Emergency Department
Cabrini
183 Wattletree Rd
Malvern
3144
Vic
Country [5] 278795 0
Australia
Other collaborator category [6] 279371 0
Individual
Name [6] 279371 0
Ainsley Treadwell
Address [6] 279371 0
Emergency Department Cabrini, 183 Wattletree Rd, Malvern, 3144 Vic
Country [6] 279371 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 294266 0
Cabrini Human Research Ethics Committee
Ethics committee address [1] 294266 0
154 Wattletree Road
Malvern VIC 3144
Ethics committee country [1] 294266 0
Australia
Date submitted for ethics approval [1] 294266 0
01/02/2016
Approval date [1] 294266 0
24/02/2016
Ethics approval number [1] 294266 0
CHREC 06-21-03-16

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
Trial website
none
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
Public notes

Contacts
Principal investigator
Name 62426 0
Mr Timothy Cowan
Address 62426 0
Emergency Department
Cabrini
184 Wattletree Rd
Malvern
Vic
3144
Country 62426 0
Australia
Phone 62426 0
+61407622694
Fax 62426 0
Email 62426 0
[email protected]
Contact person for public queries
Name 62427 0
Dr Katie Walker
Address 62427 0
Emergency Department
Cabrini
184 Wattletree Rd
Malvern
Vic
3144
Country 62427 0
Australia
Phone 62427 0
+61431272262
Fax 62427 0
Email 62427 0
[email protected]
Contact person for scientific queries
Name 62428 0
Dr Katie Walker
Address 62428 0
Emergency Department
Cabrini
184 Wattletree Rd
Malvern
Vic
3144
Country 62428 0
Australia
Phone 62428 0
+613 9508 1500
Fax 62428 0
Email 62428 0
[email protected]

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

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