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Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial
To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput.
Randomised, multicentre clinical trial.
Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit.
88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site.
Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018.
Physicians' productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians' productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done.
Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians' productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes.
Scribes improved emergency physicians' productivity, particularly during primary consultations, and decreased patients' length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia's.
ACTRN12615000607572 (pilot site); ACTRN12616000618459.
Journal Article
Heroine complex
Evie Tanaka is the put-upon personal assistant to Aveda Jupiter, her childhood best friend and San Francisco's most beloved superheroine. She's great at her job--blending into the background, handling her boss's epic diva tantrums, and getting demon blood out of leather pants. Unfortunately, she's not nearly as together when it comes to running her own life, standing up for herself, or raising her tempestuous teenage sister, Bea. But everything changes when Evie's forced to pose as her glamorous boss for one night, and her darkest secret comes out: she has powers, too. Now it's up to her to contend with murderous cupcakes, nosy gossip bloggers, and supernatural karaoke battles--all while juggling unexpected romance and Aveda's increasingly outrageous demands. And when a larger threat emerges, Evie must finally take charge and become a superheroine in her own right... or see her city fall to a full-on demonic invasion.
BOOK
The UN Secretary-General and Moral Authority
Once described by Trygve Lie as the \"most impossible job on earth,\" the position of UN Secretary-General is as frustratingly constrained as it is prestigious. The Secretary-General's ability to influence global affairs often depends on how the international community regards his moral authority. In relation to such moral authority, past office-holders have drawn on their own ethics and religious backgrounds-as diverse as Lutheranism, Catholicism, Buddhism, and Coptic Christianity-to guide the role that they played in addressing the UN's goals in the international arena, such as the maintenance of international peace and security and the promotion of human rights. InThe UN Secretary-General and Moral Authority, contributors provide case studies of all seven former secretaries-general, establishing a much-needed comparative survey of each office-holder's personal religious and moral values. From Trygve Lie's forbearance during the UN's turbulent formative years to the Nobel committee's awarding Kofi Annan and the United Nations the prize for peace in 2001, the case studies all follow the same format, first detailing the environmental and experiential factors that forged these men's ethical frameworks, then analyzing how their \"inner code\" engaged with the duties of office and the global events particular to their terms. Balanced and unbiased in its approach, this study provides valuable insight into how religious and moral leadership functions in the realm of international relations, and how the promotion of ethical values works to diffuse international tensions and improve the quality of human life around the world.
eBook
Thick as thieves : a Queen's thief novel
\"Kamet, a secretary and slave to his Mede master, has the ambition and the means to become one of the most powerful people in the Empire. But with a whispered warning the future he envisioned is wrenched away, and he is forced onto a very different path\"-- Provided by publisher.
Book
Heroine's journey
If there's one thing Beatrice Tanaka never wanted to be, it's normal. But somehow, her life has unfolded as a series of \"should haves\". Her powers of emotional projection should have made her one of the most formidable superheroes of all time. And she should have been allowed to join her older sister Evie as a full-fledged protector of San Francisco, pulverizing the city's plethora of demon threats. And this should have led to tons of adventures, excitement, and a generally fabulous life. But Evie and her superhero partner, Aveda Jupiter, still insist on seeing Bea as the impulsive, tempestuous teenager she use to be - even though she's now a totally responsible twenty something adult. And that means they've never given her a chance. And that means Bea is currently living a thoroughly normal life. She works as a bookstore lackey, hangs out with best friends Sam Fujikawa and Leah Kim, and uses her power to calm her workplace's more difficult customers. Sure, she's not technically supposed to be playing with people's mental states. But given the mundanity of her current existence, who can blame her? When a mysterious being starts communicating with Bea, hinting at an evil that's about to rise up and overtake the city, she seizes the oportunity to finally prove herself as a hero, hoping to turn her \"should haves\" into the fabulous life she's always wanted. But gaining that life may mean sacrificing everthing - and everyone - she holds dear...
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