Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department.

Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician's efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor-patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p < 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics.

Structural colouration in the Himalayan monal, hydrophobicity and refractive index modulated sensing.

The Himalayan monal is a bird in the pheasant family, and it is the national bird of Nepal. The bird possesses spectacular iridescent plumage with a range of different metallic colours. Here, we have studied the internal structure of its feathers from different parts of the bird's body and showed that its beautiful colours and iridescence are due to photonic structures present in the internal structure of the feathers. Sharp changes in the reflected brilliance were observed from the feathers upon changing the illumination conditions, such as horizontal and azimuthal angles. The feathers exhibited interesting hydrophobic properties, with the dull-coloured proximal end showing lower hydrophobicity with a contact angle between 90° and 110° compared with the iridescent distal end of a feather exhibiting a contact angle between 115° and 120°, attributed to the change in the internal structure and/or density of the feathers. A quick reversible change in colours of these feathers was observed when they were soaked in water and other liquids, which reversed upon drying. The shift in colour was suggested to be due to the swelling of the keratin layer of barbules that absorbed liquids and as a result modified the refractive index and periodicity of the internal photonic structures. The colour shift response of feathers was different in the case of alcohols and other water-based solutions, suggesting different swelling behaviour of keratin against different liquids; the water-based solution had the more pronounced effect. Such photonic modulation can be utilized in colour selective filters and sensing devices.

Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department.

Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician's efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor-patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p < 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics.

Anthocyanin-Functionalized Contact Lens Sensors for Ocular pH Monitoring.

Anthocyanins are bioactive compounds naturally found in a variety of leaves, fruits, and vegetables. Anthocyanin pigments undergo a modification in their chemical structure when exposed to different concentrations of hydrogen ions, and they were extensively studied to be used as active elements in biocompatible pH sensors. The ocular pH is a significant parameter to assess the ocular physiology in cases of postocular surgery, keratoconjunctivitis, and ocular rosacea. Contact lenses have the potential to be used as medical diagnostic devices for in situ continuous monitoring of the ocular physiology. Here, anthocyanin-functionalized contact lenses were developed as wearable sensors to monitor the ocular pH. Anthocyanin pigments were extracted from Brassica oleracea and used to functionalize the polymeric matrices of commercial soft contact lenses by soaking and drop-casting processes. Contact lenses responded to the physiological ocular pH of 6.5, 7.0, and 7.5, exhibiting a systematic color shift from pink (pH 6.5) to purple (pH 7.0) and blue (pH 7.5). The functionalization of contact lens sensors was evaluated as a function of the dye concentration. Quantitative values were obtained by comparing the RGB triplets of the colors obtained with the naturally extracted dye and with delphinidin chloride dye in 0.0 to 1.5 mmol L-1 aqueous solution. The functionalization of contact lenses was studied as a function of the soaking time, resulting in best results when soaking for 24 h. The dye leakage from the contact lenses in deionized water was evaluated, and a negligible leakage after 18 h was observed. Poly-2-hydroxy ethylmethacrylate contact lenses were fabricated and cross-linked with anthocyanin dye, resulting in a slight color shift upon pH changes from 6.5 to 7.4. Contact lens pH sensors may be used to continuously monitor the ocular pH at point-of-care settings.

Optical bandgap modelling from the structural arrangement of carbon nanotubes.

The optical bandgap properties of vertically-aligned carbon nanotube (VACNT) arrays were probed through their interaction with white light, with the light reflected from the rotating arrays measured with a spectrometer. The precise deterministic control over the structure of vertically-aligned carbon nanotube arrays through electron beam lithography and well-controlled growth conditions brings with it the ability to produce exotic photonic crystals over a relatively large area. The characterisation of the behaviour of these materials in the presence of light is a necessary first step toward application. Relatively large area array structures of high-quality VACNTs were fabricated in square, hexagonal, circular and pseudorandom patterned arrays with length scales on the order of those of visible light for the purpose of investigating how they may be used to manipulate an impinging light beam. In order to investigate the optical properties of these arrays a set of measurement apparatus was designed which allowed the accurate measurement of their optical bandgap characteristics. The patterned samples were rotated under the illuminating white light beam, revealing interesting optical bandgap results caused by the changing patterns and relative positions of the scattering elements (VACNTs).