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[BMJ发表论文]:配备速记员对急诊科医生工作效率及患者周转率的影响:一项多中心随机试验
2019年03月17日 时讯速递, 进展交流 暂无评论

Research

Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial

Katherine Walker, Michael Ben-Meir, William Dunlop, et al

https://doi.org/10.1136/bmj.l121 

BMJ 2019;364:l121

Abstract

Objectives 目的

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.

评估澳大利亚急诊科医生配备速记员后工作效率的改变,以及对患者周转率的影响。

Design 设计

Randomised, multicentre clinical trial.

随机多中心临床试验

Setting 场景

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.

Victoria州5个急诊科在试验期间对速记员进行培训。参研中心代表了澳大利亚急诊科的情况:公立医院(城市,三级,地区转诊中心及儿科)及私立非盈利医院。

Participants 研究对象

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.

88名医生均为永久性雇员,每周值班一次以上,为急诊科顾问医生或处于培训最后一年的高年住院医生。在一个中心对12名速记员进行培训,并在各个参研中心轮转。

Interventions 干预措施

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.

医生根据常规排班进行工作,随机分配在上班期间配备速记员。从2015年11月至2018年1月,每个中心至少需要100个配备及未配备速记员的班次。

Main outcome measures 主要预后指标

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.

医生工作效率(总患者数,首次就诊患者数);患者周转率(门医时间,急诊留滞时间);急诊科区域的医生工作效率。对速记员自我报告的危害进行分析,并进行成本效益分析。

Results 结果

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.

共收集了589个配备速记员班次(5098名患者)及3296个未配备速记员班次(23838名患者)的数据。配备速记员能够提高医生工作效率,从每名医生每个小时看1.13名患者 (95% 可信区间 1.11 to 1.17) 增加到 1.31名患者 (1.25 to 1.38),增加15.9%。首次就诊患者从每名医生每小时0.83名 (0.81 to 0.85) 增加到 1.04名 (0.98 to 1.11),增加25.6%。门医时间没有改变。急诊留滞中位时间从192分钟(四分位区间108-311)缩短到173分钟(96-208),缩短19分钟(P<0.001)。高年医生检诊时配备速记员获益最大,在亚急性/快速通道配备速记员获益最小。未报告有关速记员的任何明显危害。基于工作效率及患者周转获益的成本效益分析显示,采用速记员的经济效益显著。

Conclusions 结论

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.

配备速记员能够显著改善急诊科医生工作效率,尤其对于首次就诊患者,并缩短急诊滞留时间。后续研究应当评估速记员在医疗系统与澳大利亚相似的其他国家中的作用。

Trial registration 试验注册

ACTRN12615000607572 (pilot site); ACTRN12616000618459.

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