Burnout in ENT France: Update and risk factors; a STROBE analysis

BACKGROUND

Burnout can significantly impact practitioners and their co-workers, and hence patients. There are no data for the prevalence of burnout in French ENT specialists, or for associated risk factors.

MATERIAL AND METHODS

A French national cross-sectional online survey was performed on the initiative of the ENT National Professional Council (CNPORL), contacting all ENT specialists whose e-mail address was known to the French Society of ENT, the National Professional Council or the National ENT Union. The 22-question Maslach Burnout Inventory (MBI) was sent out, along with 16 extra questions on possible risk factors.

OBJECTIVES

The study sought to assess the prevalence and severity of burnout, using the MBI, and to analyze risk factors.

RESULTS

Among the 1936 physicians, 406 contacted responded to the questionnaire (21%). Mean age was 47±14 years (range, 25-77 years); 53% male, 47% female. 196 (48%) reported burnout, including 20 (5%) severe burnout. Independent risk factors for burnout of whatever severity, comprised social interaction issues, history of identified burnout, and medicolegal pressures. Social interaction issues were independently associated with specifically severe burnout.

CONCLUSIONS

Burnout affected almost half of respondents. There are identifiable risk factors, for which improvements could be implemented.

Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics

BACKGROUND

Section 507 of the VA MISSION Act of 2018 mandated a 2-year pilot study of medical scribes in the Veterans Health Administration (VHA), with 12 VA Medical Centers randomly selected to receive scribes in their emergency departments or high wait time specialty clinics (cardiology and orthopedics). The pilot began on June 30, 2020, and ended on July 1, 2022.

OBJECTIVE

Our objective was to evaluate the impact of medical scribes on provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act.

DESIGN

Cluster randomized trial, with intent-to-treat analysis using difference-in-differences regression.

PATIENTS

Veterans using 18 included VA Medical Centers (12 intervention and 6 comparison sites).

INTERVENTION

Randomization into MISSION 507 medical scribe pilot.

MAIN MEASURES

Provider productivity, wait times, and patient satisfaction per clinic-pay period.

KEY RESULTS

Randomization into the scribe pilot was associated with increases of 25.2 relative value units (RVUs) per full-time equivalent (FTE) (p < 0.001) and 8.5 visits per FTE (p = 0.002) in cardiology and increases of 17.3 RVUs per FTE (p = 0.001) and 12.5 visits per FTE (p = 0.001) in orthopedics. We found that the scribe pilot was associated with a decrease of 8.5 days in request to appointment day wait times (p < 0.001) in orthopedics, driven by a 5.7-day decrease in appointment made to appointment day wait times (p < 0.001), and observed no change in wait times in cardiology. We also observed no declines in patient satisfaction with randomization into the scribe pilot.

CONCLUSIONS

Given the potential improvements in productivity and wait times with no change in patient satisfaction, our results suggest that scribes may be a useful tool to improve access to VHA care. However, participation in the pilot by sites and providers was voluntary, which could have implications for scalability and what effects could be expected if scribes were introduced to the care process without buy-in. Cost was not considered in this analysis but is an important factor for future implementation.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04154462.

Medical scribes improve documentation consistency and efficiency in an otolaryngology clinic

OBJECTIVE

Scribes in medical practice enable more efficient documentation requirements but insufficient analyses have occurred to fully evaluate their efficacy in otolaryngology. We analyzed pre/post metrics of scribe implementation that may aid practitioners in determining feasibility for use in their practices.

METHODS

1808 patient charts were analyzed in The Epic Electronic Medical Record system (EMR) (903 pre and 905 post scribe implementation). We measured: clinic volumes, time saved in documentation, chart billing level, and lag days of chart closure.

RESULTS

Patient volumes increased by 3.02% with an 11-17% decrease in time spent in clinic/day and lag days for billing. The distribution of visits for new patients was 17.75% level 2, 51.45% level 3, 29.71% level 4 before the scribe and was 6.83% level 2, 89.21% level 3, 3.96% level 4 after the scribe. For established patients it was 3.97% level 2, 84.92% level 3, 8.93% level 4 before and 0.34% level 2, 91.76% level 3, 7.73% level 4 after. The change in level of documentation for established and new patients pre and post scribe implementation was not statistically significant (p = 0.821, 0.063, respectively). Charts were closed within 0 to 7 days with the implementation of a scribe instead of 7-21 days when awaiting dictations for transcription.

CONCLUSIONS

The implementation of a scribe in an academic otolaryngology clinic facilitated more rapid completion of documentation while decreasing provider hours/day in clinic. We feel the analysis can be generalized to otolaryngology practitioners in general and the data structures we implemented are usable for others.

Interfacing With the Electronic Health Record (EHR): A Comparative Review of Modes of Documentation

Electronic health records (EHRs) have provided physicians with a systematic framework for collecting patient data, organizing notes from the healthcare team, and managing the daily workflow in the modern era of healthcare. Despite these advantages, EHRs have proven to be problematic for clinicians. The burdensome regulations requiring increased documentation with the EHR paradigm have led to inefficiencies from data-entry requirements forcing physicians to spend an inordinate amount of time on it, affecting the time available for direct patient care as well as leading to professional burnout. As a result, new modalities such as speech recognition, medical scribes, pre-made EHR templates, and digital scribes [a form of artificial intelligence (AI) based on ambient speech recognition] are increasingly being used to reduce charting time and increase the time available for patient care. The purpose of our review is to provide an up-to-date review of the literature on these modalities including their benefits and shortcomings, to help physicians and other medical professionals choose the best methods to document their patient-care encounters efficiently and effectively.

Patient Satisfaction With Otolaryngology Care: Stratification by Race, Age, Gender, Income, and Language

OBJECTIVE

To understand how race, gender, income, and language are correlated with patient satisfaction scores.

STUDY DESIGN

Cross-sectional analysis of patient satisfaction data.

SETTING

An urban/suburban academic otolaryngology practice.

METHODS

Patients presenting for outpatient otolaryngology visits from 2017 to 2020 were surveyed for patient satisfaction following a visit with their otolaryngology provider. Categorical responses and numerical responses were collected regarding overall satisfaction as well as a variety of more specific satisfaction questions. Responses were matched to both provider characteristics and patient demographic data. Differences in satisfaction by demographic data were assessed with descriptive statistics as well as a multivariable mixed-effect model to adjust for repeated responder data and control for confounding factors.

RESULTS

In total, 55,469 surveys were included, the majority of which were from white, English-speaking patients. Overall satisfaction levels were very high across all questions. The individual provider was associated highly with satisfaction, but provider gender was not. Race, age, and gender of the patient had a statistically significant impact on patient satisfaction, with higher levels of satisfaction among patients who were older, white, and male; income and language did not.

CONCLUSION

Patient factors including race, age, and gender had a significant impact on ratings on outpatient otolaryngology patient satisfaction surveys, with nonwhite, younger, female patients reporting lower scores.

The implementation of scribing within a medical school's pre-clinical curriculum: pilot study

BACKGROUND

Medical students matriculating from their preclinical curriculum into clinical clerkships face a significant learning curve when using an electronic medical record (EMR) system for clinical documentation. With the trend toward reduction in preclinical medical education, students now have fewer opportunities to optimize their note-writing and overall clinical skills before transitioning to patient-care settings.

METHODS

This study sought to investigate how a structured medical scribing program in an outpatient clinic helps bridge the gap between traditional preclinical and clinical curricula in medical education. A small cohort of medical students were trained in medical scribing within our institutions' existing preclinical preceptorship program. We surveyed students, preceptors, and patients during the project to better understand confidence around documentation, the EMR, and the impact of the scribing program on workflow efficiency and patient satisfaction.

RESULTS

There was no significant difference between the scribe and non- scribe students in their confidence documenting a patient encounter or navigating EMR (all p > .05). Our study demonstrated that preceptors for scribe students reported a significant decrease in documentation time compared to non-scribes (Mdiff = - 5.75, p = .02), with no negative impact on patient satisfaction.

CONCLUSIONS

Medical scribing can be a tool to further develop medical trainees in clinical documentation and help prepare them for the responsibilities during clinical years. When summing the per encounter time savings over the course of a half or full clinic day, scribing can return a significant amount of time back to preceptors. The time saved by the preceptor needs to be further investigated to determine if the time can lend itself towards better patient care, student-specific feedback, focused teaching, or even mentoring.

Effect of Medical Scribes on Throughput, Revenue, and Patient and Provider Satisfaction: A Systematic Review and Meta-analysis

STUDY OBJECTIVE

Documentation in the medical record increases clerical burden to clinicians and reduces time available to spend with patients, thereby leading to less efficient care and increased clinician stress. Scribes have been proposed as one approach to reduce this burden on clinicians and improve efficiency. The primary objective of this study is to assess the effect of scribes on throughput, revenue, provider satisfaction, and patient satisfaction in both the emergency department (ED) and non-ED setting.

METHODS

PubMed, Scopus, the Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature database, Google Scholar, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched for studies assessing the effect of scribes versus no scribes on the following outcomes: patients per hour, relative value units (RVUs) per hour, RVUs per encounter, clinic length of stay, time to disposition, ED length of stay, ED length of stay for admitted patients, ED length of stay for discharged patients, provider satisfaction, and patient satisfaction. Data were dual extracted into a predefined work sheet, and quality analysis was performed with the Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Subgroup analyses were planned between ED versus non-ED studies.

RESULTS

We identified 39 studies comprising greater than 562,682 patient encounters. Scribes increased patients treated per hour by 0.30 (95% confidence interval [CI] 0.10 to 0.51). Scribes increased RVUs per encounter by 0.14 (95% CI 0.03 to 0.24) and RVUs per hour by 0.55 (0.30 to 0.80). There was no difference in time to disposition (5.74 minutes; 95% CI -2.63 to 14.10 minutes) or ED length of stay (-3.44 minutes; 95% CI -7.68 to 0.81 minutes), although a difference was found in clinic length of stay (5.74 minutes; 95% CI 0.42 to 11.05 minutes). Fourteen of 16 studies reported favorable provider satisfaction with a scribe. Seven of 18 studies reported favorable patient satisfaction with a scribe. No studies reported negative provider or patient satisfaction with scribes.

CONCLUSION

Overall, we found that scribes improved RVUs per hour, RVUs per encounter, patients per hour, provider satisfaction, and patient satisfaction. However, we did not identify an improvement in ED length of stay. Future studies are needed to determine the cost-benefit effect of scribes and ED volume necessary to support their use.

Prevalence of and Associations With Distress and Professional Burnout Among Otolaryngologists: Part II, Attending Physicians

OBJECTIVE

To ascertain the prevalence of and associations with distress and professional burnout among academic otolaryngology attending physicians.

STUDY DESIGN

Cross-sectional survey.

SETTING

Twelve US academic otolaryngology programs.

METHODS

A questionnaire was administered that encompassed sociodemographic and professional features, the Expanded Physician Well-being Index for distress, the 2-item Maslach Burnout Inventory for professional burnout, the Patient Health Questionnaire-2 screen for major depressive disorder, and the Generalized Anxiety Disorder-2 screen for generalized anxiety disorder.

RESULTS

The survey response rate was 56% and included 186 attending physicians. The average respondent age was 47 years; 72% were men; 93% were married or partnered; and 86% had children. Distress was present in 40%, professional burnout in 26%, positive depression screening in 8%, and positive anxiety screening in 11%. In a univariable setting, age, hours worked in a typical week, nights on call in a typical week, and years of practice were significantly associated with distress, although in a multivariable setting, only hours worked in a typical week remained significantly associated with a positive Expanded Physician Well-being Index screen (odds ratio for each 10-hour increase, 2.61; 95% CI, 1.73-3.93; P < .001). In a univariable setting, hours worked in a typical week was significantly associated with a positive Maslach Burnout Inventory screen.

CONCLUSION

Distress or professional burnout occurs in more than a quarter of academic otolaryngology attending physicians, whereas the prevalence of depression or anxiety is approximately 10%. The number of hours worked per week had the strongest association with distress and burnout. These findings may be used to develop and implement programs to promote physician well-being and mitigate professional burnout.