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Trial registered on ANZCTR


Registration number
ACTRN12613000763741
Ethics application status
Approved
Date submitted
25/06/2013
Date registered
9/07/2013
Date last updated
15/04/2015
Type of registration
Prospectively registered

Titles & IDs
Public title
Cabrini Scribe Trial - a pilot study to investigate the relationship between emergency department scribes and emergency physician productivity - to compare physician productivity, billing and staff and patient satisfaction with and without the assistance of a scribe during emergency medicine consultations
Scientific title
A pilot study of the relationship between emergency department scribes and emergency physician productivity, billing and staff and patient satisfaction
Secondary ID [1] 282730 0
Nil
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Emergency physician efficiency 289462 0
Emergency physician billing accuracy 289463 0
Emergency Department staff satisfaction related to medical scribes 289464 0
Condition category
Condition code
Public Health 289776 289776 0 0
Health service research

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
A trained medical scribe will assist an emergency physician during emergency consultations. They will take notes as directed and will assist with clerical tasks as directed. The intervention will take place for four consecutive weeks commencing September 9th 2013.
Intervention code [1] 287393 0
Other interventions
Comparator / control treatment
An emergency physician will carry out their usual work without the assistance of a medical scribe which includes their usual note taking and clerical duties. Emergency physician shifts matched in advance for physician, day, time and work area will be selected from July and August shifts in 2013.
Control group
Historical

Outcomes
Primary outcome [1] 289860 0
Data on physician patients seen per hour in similar circumstances in close time proximity to the intervention sampling
Mean and standard deviation (SD) of the number of patients seen by each physician per hour
Timepoint [1] 289860 0
Intervention: September 9th 2013 and onwards for a period of 4 weeks
Control: July to August 2013 inclusive
Secondary outcome [1] 303402 0
billing rates per patient obtained from hospital database
Timepoint [1] 303402 0
Intervention: September 9th 2013 and onwards for a period of 4 weeks
Control: July to August 2013 inclusive
Secondary outcome [2] 303403 0
staff satisfaction survey - specifically designed for this study
Timepoint [2] 303403 0
Intervention: September 9th 2013 and onwards for a period of 4 weeks
Control: July to August 2013 inclusive
Secondary outcome [3] 303404 0
patient waiting times - obtained from hospital data base
Timepoint [3] 303404 0
Intervention: September 9th 2013 and onwards for a period of 4 weeks
Control: July to August 2013 inclusive

Eligibility
Key inclusion criteria
All scribed shifts and scribed patient encounters during the trial period including any where the scribe was supposed to be present but wasn't. If the scribe was asked to leave an encounter by the patient or physician the encounter will be included in the analysis.

The physicians enrolled to participate will be a convenience sample of physicians available during the specified time period. They will be voluntarily consenting to participate.

The scribe used will be one trained scribe identified in advance. This scribe will work with all the physicians.
Minimum age
No limit
Maximum age
No limit
Gender
Both males and females
Can healthy volunteers participate?
Yes
Key exclusion criteria
Unscribed shifts

Study design
Purpose of the study
Educational / counselling / training
Allocation to intervention
Non-randomised trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
The scribed shifts will be allocated to selected willing participant physicians a month preceeding the trial intervention.
The physicians will be regular cabrini physicians who are agreable to participate in the trial. These physicians will be aware of the trial aims.
The scribe will attend for a month and will work preallocated shifts with the physicians.
The patient encounters within each shift will not be able to be chosen as these are defined by rules surrounding patient allocation that are always the same.
There is computer generated allocation of the next patient to be seen and there are shift rules around regional allocation of emergency department physician allocation of work duties.
These are closely enforced and only interrupted by a patient requiring resuscitation or immediate medical attention.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Single group
Other design features
Phase
Not Applicable
Type of endpoint(s)
Safety/efficacy
Statistical methods / analysis
The minimal clinical effect size that would be useful to pursue would be an efficiency gain from 1.0 patient per hour to 1.2 patients per hour (a 20% increase).
A sample size of 100 in each period would allow this difference to be detected at a 5% significance level and 80% power (two-sided) assuming a relatively conservative estimate of the SD of the number of patients seen per hour of 0.5.
The mean number of encounters per hour will be compared for the two groups using t-tests. Similarly, the mean billing rates, staff satisfaction and patient waiting times will be compared for the groups using parametric or non-parametric tests as appropriate.

Recruitment
Recruitment status
Completed
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
VIC
Recruitment hospital [1] 1156 0
Cabrini Hospital - Malvern - Malvern
Recruitment postcode(s) [1] 7005 0
3144 - Malvern

Funding & Sponsors
Funding source category [1] 287503 0
Hospital
Name [1] 287503 0
Cabrini
Address [1] 287503 0
183 Wattletree Rd
Malvern
3144
VIC
Country [1] 287503 0
Australia
Primary sponsor type
Individual
Name
Dr Katherine Walker
Address
Emergency department
Cabrini Hospital
183 Wattletree Rd
Malvern
3144
VIC
Country
Australia
Secondary sponsor category [1] 286241 0
Individual
Name [1] 286241 0
Dr Phebe O'Mullane
Address [1] 286241 0
Emergency department
Cabrini Hospital
183 Wattletree Rd
malvern
3144
VIC
Country [1] 286241 0
Australia
Secondary sponsor category [2] 286242 0
Individual
Name [2] 286242 0
Dr Michael Ben-Meir
Address [2] 286242 0
Emergency department
Cabrini Hospital
183 Wattletree Rd
malvern
3144
VIC
Country [2] 286242 0
Australia
Other collaborator category [1] 277477 0
Individual
Name [1] 277477 0
Dr Margaret Staples
Address [1] 277477 0
Monash Department of Clinical Epidemiology, Cabrini Hospital
Department of Epidemiology and Preventive Medicine
183 Wattletree Rd
Malvern Vic 3144
Country [1] 277477 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 289480 0
Cabrini Hospital Ethics Committee
Ethics committee address [1] 289480 0
Cabrini Hospital
HREC
183 Wattletree Rd
Malvern Vic 3144
Ethics committee country [1] 289480 0
Australia
Date submitted for ethics approval [1] 289480 0
27/06/2013
Approval date [1] 289480 0
16/07/2013
Ethics approval number [1] 289480 0
10-05-08-13

Summary
Brief summary
There is a rising medical cost base in emergency medicine. There is a rising seniority of medical staff required to safely perform the role of physician in an emergency department. The currently accepted productivity of a FACEM is one patient per hour. Much of this time is spent writing and printing notes, faxing documents and contacting physicians. None of this work requires the skill set of an emergency physician and could be performed by a well-trained medical scribe or secretary.

To date scribes have not been used in Australian Emergency Departments and offer a novel way of addressing emergency physician productivity without compromising the quality of emergency physician work.

The degree that a medical scribe increases emergency physician productivity in emergency medicine in Australia has not been determined.

This is a pilot trial to investigate whether a medical scribe would increase emergency physician efficiency
Trial website
Trial related presentations / publications
presented at ACEM14, Melbourne, December 2014

published in electronic and written form:
Scribes in an Australian private emergency department: A description of physician productivity, walker K, ben-Meir M, O'Mullane et al, Emerg Med Australas, vol 26 issue 6, 543-8
Public notes

Contacts
Principal investigator
Name 41022 0
Dr Katherine Walker
Address 41022 0
Emergency department
Cabrini Hospital
183 Wattletree Rd
malvern 3144
VIC
Country 41022 0
Australia
Phone 41022 0
+61 431 272 262
Fax 41022 0
Email 41022 0
katie_walker01@yahoo.com.au
Contact person for public queries
Name 41023 0
Dr Katie Walker
Address 41023 0
Emergency department
Cabrini Hospital
183 Wattletree Rd
malvern 3144
VIC
Country 41023 0
Australia
Phone 41023 0
+61 431 272 262
Fax 41023 0
Email 41023 0
katie_walker01@yahoo.com.au
Contact person for scientific queries
Name 41024 0
Dr Katie Walker
Address 41024 0
Emergency department
Cabrini Hospital
183 Wattletree Rd
malvern 3144
VIC
Country 41024 0
Australia
Phone 41024 0
+61 431 272 262
Fax 41024 0
Email 41024 0
katie_walker01@yahoo.com.au

No information has been provided regarding IPD availability
Summary results
Have study results been published in a peer-reviewed journal?
Other publications
Have study results been made publicly available in another format?
Results – basic reporting
Results – plain English summary