Impact of Scribes on Performance Indicators in the Emergency Department
Impact of Scribes on Performance Indicators in the Emergency Department
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DOI：
10.1111/j.1553-2712.2010.00718.x
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发表时间：
2010-05-01
影响因子：
4.4
通讯作者：
Merlin, Mark A.
中科院分区：
文献类型：
--
作者：
Arya, Rajiv;Salovich, Danielle M.;Merlin, Mark A.
目的：我们的目的是量化的影响，文士对三个措施的急诊医生（EP）的生产力在成人急诊科（艾德）：方法：对于这项回顾性研究，243个临床班次（无论是10或12小时）的13个EP工作在18个月的时间内被选中进行评估。检查了工资数据表，以确定这些班次是否由抄写员覆盖、未覆盖或部分覆盖（少于4小时）;部分覆盖的班次与未覆盖的班次分组进行分析。在一个聚类设计中，按医生将覆盖的变化与未覆盖的变化进行比较。分层线性模型用于研究轮班期间使用记录员的患者百分比与EP生产率之间的关联，EP生产率由每小时患者数、每小时相对价值单位（RVU）和出院周转时间（达特）测量。轮班期间，划线器使用每增加10%，每小时RVU增加0.24个单位（95%置信区间[CI] = 0.10至0.38，p = 0.0011）。轮班期间，每增加10%的划线器使用，每小时的患者数量增加0.08（95% CI = 0.04至0.12，p = 0.0024）。达特与划线器使用无显著相关性。这些关联在解释了医师助理（PA）的使用后并没有失去意义。结论：在这项回顾性研究中，EP使用抄写员与整体生产力的提高相关，这是通过EP每小时治疗的患者（Pt/hr）和每小时产生的RVU来衡量的，但不是通过达特到出院来衡量的。490-494（C）2010由学术急诊医学学会
Objectives: The objective was to quantify the effect of scribes on three measures of emergency physician (EP) productivity in an adult emergency department (ED).Methods: For this retrospective study, 243 clinical shifts (of either 10 or 12 hours) worked by 13 EPs during an 18-month period were selected for evaluation. Payroll data sheets were examined to determine whether these shifts were covered, uncovered, or partially covered (for less than 4 hours) by a scribe; partially covered shifts were grouped with uncovered shifts for analysis. Covered shifts were compared to uncovered shifts in a clustered design, by physician. Hierarchical linear models were used to study the association between percentage of patients with which a scribe was used during a shift and EP productivity as measured by patients per hour, relative value units (RVUs) per hour, and turnaround time (TAT) to discharge.Results: RVUs per hour increased by 0.24 units (95% confidence interval [CI] = 0.10 to 0.38, p = 0.0011) for every 10% increment in scribe usage during a shift. The number of patients per hour increased by 0.08 (95% CI = 0.04 to 0.12, p = 0.0024) for every 10% increment of scribe usage during a shift. TAT was not significantly associated with scribe use. These associations did not lose significance after accounting for physician assistant (PA) use.Conclusions: In this retrospective study, EP use of a scribe was associated with improved overall productivity as measured by patients treated per hour (Pt/hr) and RVU generated per hour by EPs, but not as measured by TAT to discharge.ACADEMIC EMERGENCY MEDICINE 2010; 17: 490-494 (C) 2010 by the Society for Academic Emergency Medicine