Clerical Burden Research Articles

Developing a generalisable stratification approach for clerical review of linked data

ObjectiveData linkage is a vital process in the creation of many national statistics, but understanding the quality of linked data is currently highly inefficient. To find errors, data must be reviewed by humans which is costly and lengthy. Sampling is used to reduce the clerical burden. This research aims to develop a method for stratifying links to create representative samples while reducing the number reviewed. The final method will enable nuanced stratification of data for review whilst optimising resource efficiency. The objectives are to: ensure that the method is adaptable across diverse datasets, achieve full automation, ensure scalability to accommodate large datasets. ApproachOur approach centres on designing an algorithm that responds to the variability in the data distribution of probabilistic scores and stratify accordingly. The intention is for the developed method to automatically adjust its parameters, such as strata threshold and numbers based on the data’s characteristics. The research involves a comparative analysis of the performance of dynamic- and percentile-based stratification against the current standard practice of static threshold stratification. ResultsTests are ongoing to compare the above methods on a variety of metrics including homogeneity of strata, total variance, and between-strata distance. Findings will be presented at the conference. ConclusionsWe hope to design a robust, generalisable and scalable stratification method that can be integrated into a Linkage pipeline. Implications Implementing the method will help to improve the quality of national statistics, ensuring more accurate, reliable and timely outputs are produced in a resource efficient manner.

The Impact of Large Language Models on Medical Education: Preparing for a Revolutionary Shift in Doctor Training

Artificial intelligence holds immense potential to transform healthcare, though its widespread implementation has yet to be realized. This lag is partly because efforts have traditionally focused on easily predicted rather than easily actionable problems. Large language models (LLMs) represent a paradigm shift in our approach to artificial intelligence due to their accessibility and the fact that frontline clinicians are already testing them and identifying potential applications. LLMs in healthcare could significantly reduce clerical burdens, enhance patient education, and more. As we enter this new era of healthcare delivery, LLMs will bring both opportunities and challenges to medical education.[1-5] Future models should be designed to help trainees develop clinical reasoning skills, promote evidence-based medicine, and provide case-based training opportunities. LLMs may also necessitate changes in how clinical documentation is taught. Additionally, trainees can contribute to training and refining the next generation of LLMs as we explore the best ways to integrate these models into medical education. Whether we are ready or not, LLMs will soon be integrated into various aspects of clinical practice. We must collaborate closely with students and educators to ensure these models are developed with trainees in mind, guiding medical education responsibly into the next era.[21]

Development of a Visit Facilitator Role to Assist Physicians in an Ambulatory Consultative Medical Practice

ObjectiveTo decrease the electronic health record (EHR) clerical burden and improve patient/clinician satisfaction, allied health staff were trained as visit facilitators (VFs) to assist the physician in clinical and administrative tasks. Patients and MethodsFrom December 7, 2020, to October 11, 2021, patients with complex medical conditions were evaluated by an internal medicine physician in an outpatient general internal medicine (GIM) consultative practice at a tertiary care institution. A VF assisted with specific tasks before, during, and after the clinical visit. Presurvey and postsurvey assessments were performed to understand the effect of the VF on clinical tasks as perceived by the physician. ResultsA total of 57 GIM physicians used a VF, and 41 (82%) physicians and 39 (79%) physicians completed the pre-VF and post-VF surveys, respectively. Physicians reported a significant reduction in time reviewing outside materials, updating pertinent information, and creating/modifying EHR orders (P<.05). Clinicians reported improved interactions with patients and on-time completion of clinical documentation. In the pre-VF survey, “too much time spent” was the most common response for reviewing outside material, placing/modifying orders, completing documentation/clinical notes, resolving in-baskets, completing dismissal letters, and completing tasks outside of work hours. In the post-VF survey, “too much time spent” was not the most common answer to any question. Satisfaction improved in all areas (P<.05). ConclusionVFs significantly reduced the EHR clinical burden and improved GIM physician practice satisfaction. This model can potentially be used in a wide range of medical practices.

The Impact of an Electronic Portal on Patient Encounters in Primary Care: Interrupted Time-Series Analysis.

Electronic patient portals are online applications that allow patients access to their own health information, a form of asynchronous virtual care. The long-term impact of portals on the use of traditional primary care services is unclear, but it is an important question at this juncture, when portals are being incorporated into many primary care practices. We sought to investigate how an electronic patient portal affected the use of traditional, synchronous primary care services over a much longer time period than any existing studies and to assess the impact of portal messaging on clinicians' workload. We conducted a propensity-score-matched, open-cohort, interrupted time-series evaluation of a primary care portal from its implementation in 2010. We extracted information from the electronic medical record regarding age, sex, education, income, family health team enrollment, diagnoses at index date, and number of medications prescribed in the previous year. We also extracted the annual number of encounters for up to 8 years before and after the index date and provider time spent on secure messaging through the portal. A total of 7247 eligible portal patients and 7647 eligible potential controls were identified, with 3696 patients matched one to one. We found that portal registration was associated with an increase in the number of certain traditional encounters over the time period surrounding portal registration. Following the index year, there was a significant jump in annual number of visits to physicians in the portal arm (0.42 more visits/year vs control, P<.001) but not for visits to nurse practitioners and physician assistants. The annual number of calls to the practice triage nurses also showed a greater increase in the portal arm compared to the control arm after the index year (an additional 0.10 calls, P=.006). The average provider time spent on portal-related work was 5.7 minutes per patient per year. We found that portal registration was associated with a subsequent increase in the number of some traditional encounters and an increase in clerical workload for providers. Portals have enormous potential to truly engage patients as partners in their own health care, but their impact on use of traditional health care services and clerical burden must also be considered when they are incorporated into primary care.

Burnout Related to Electronic Health Record Use in Primary Care.

Physician burnout has been increasing in the United States, especially in primary care, and the use of Electronic Health Records (EHRs) is a prominent contributor. This review article summarizes findings from a PubMed literature search that shows the significant contributors to EHR-related burnout may be documentation and clerical burdens, complex usability, electronic messaging and inbox, cognitive load, and time demands. Documentation requirements have escalated and have inherently changed from paper-based records. Many clerical tasks have also shifted to become additional physician responsibilities. When considering factors of efficiency, effectiveness, and user satisfaction, EHRs overall have an inferior usability score when compared to other technologies. The volume and organization of data along with alerts and complex interfaces require a substantial cognitive load and result in cognitive fatigue. Patient interactions and work-life balances are negatively affected by the time requirements of EHR tasks during and after clinic hours. Patient portals and EHR messaging have created a separate source of patient care outside of face-to-face visits that is often unaccounted productivity and not reimbursable.

Assessment of patient perceptions of technology and the use of machine-based learning in a clinical encounter

BackgroundElectronic health records (EHR) were implemented to improve patient care, reduce healthcare disparities, engage patients and families, improve care coordination, and maintain privacy and security. Unfortunately, the mandated use of EHR has also resulted in significantly increased clerical and administrative burden, with physicians spending an estimated three-fourths of their daily time interacting with the EHR, which negatively affects within-clinic processes and contributes to burnout. In-room scribes are associated with improvement in all aspects of physician satisfaction and increased productivity, though less is known about the use of other technologies such as Google Glass (GG), Natural Language Processing (NLP) and Machine-Based Learning (MBL) systems. Given the need to decrease administrative burden on clinicians, particularly in the utilization of the EHR, there is a need to explore the intersection between varying degrees of technology in the clinical encounter and their ability to meet the aforementioned goals of the EHR. AimsThe primary aim is to determine predictors of overall perception of care dependent on varying mechanisms used for documentation and medical decision-making in a routine clinical encounter. Secondary aims include comparing the perception of individual vignettes based on demographics of the participants and investigating any differences in perception questions by demographics of the participants. MethodsVideo vignettes were shown to 498 OhioHealth Physician Group patients and to ResearchMatch volunteers during a 15-month period following IRB approval. Data included a baseline survey to gather demographic and background characteristics and then a perceptual survey where patients rated the physician in the video on 5 facets using a 1 to 5 Likert scale. The analysis included summarizing data of all continuous and categorical variables as well as overall perceptions analyzed using multivariate linear regression with perception score as the outcome variable. ResultsUnivariate modeling identified sex, education, and type of technology as three factors that were statistically significantly related to the overall perception score. Males had higher scores than females (p = 0.03) and those with lower education had higher scores (p < 0.001). In addition, the physician documenting outside of the room encounter had statistically significantly higher overall perception scores (mean = 22.2, p < 0.001) and the physician documenting in the room encounter had statistically significantly lower overall perception scores (mean = 15.3, p < 0.001) when compared to the other vignettes. Multivariable modeling identified all three of the univariably significant factors as independent factors related to overall perception score. Specifically, high school education had higher scores than associate/bachelor education (LSM = 21.6 vs. 19.9, p = 0.0002) and higher scores than master/higher education (LSM = 21.6 vs. 19.5, p < 0.0001). No differences between age groups were found on the individual perception scores. Males had higher scores than females on ‘The doctor clearly explained the diagnosis and treatment to the patient’ and ‘The doctor was sincere and trustworthy’. High school education had higher scores than associate/bachelor and master/higher on all five individual perception scores. ConclusionThe study found sex, education, and type of technology were significant indicators for overall perception of varying technologies used for documentation and medical decision-making in a routine clinical encounter. Importantly, the vignette depicting the least interaction with the EHR received the most positive overall perception score, while the vignette depicting the physician utilizing the EHR during the interaction received the least positive overall perception score. This suggests patients most value having the full attention of the physician and feel less strongly about differentiating the logistics of data transcription and medical decision-making, provided they feel engaged during the interaction. Therefore, the authors suggest maximizing face-to-face time in the integration of technology into the clinical encounter, allowing for increased perceptions of personal attention in the patient-physician interaction.

Implementation of a Nurse-Driven Medication Ordering Protocol to Improve Clinician and Nursing Experiences.

Paging and text messaging to request new orders remain common means of communication between clinicians and nurses in the hospital setting. However, sending and triaging multiple pages can lead to interruptions in other clinical duties. A medication order delegation protocol allowing for nurse-driven ordering of low-risk medications was developed with an objective of decreasing potentially avoidable pages. The aim of this study was to evaluate the impact of implementing this protocol on nurse and clinician perceptions of clerical burden and satisfaction. A survey assessing satisfaction with the process of obtaining medications in this protocol and the perception of clerical burden associated with ordering them before and after delegation protocol implementation was completed by over 160 clinicians and nurses. Survey respondents reported increased satisfaction and decreased clerical burden associated with the implementation of the delegation protocol. These results suggest the potential for delegation protocols to limit clerical burden associated with paging.

Restoring Meaningful Content to the Medical Record: Standardizing Measurement Could Improve EHR Utility While Decreasing Burden

Electronic health records (EHRs) dominate clinicians’ time.1 This time on the computer is often not well spent: EHRs are known for their poor usability and clerical burden, producing “bloated” notes with patient narratives and clinical reasoning lost in a sea of extraneous data and text.2 Yet the EHR’s exact purpose in clinical practice and documentation remains conflicted, with billing and clerical roles often eclipsing communication and decision-making capabilities. When fully realized, the EHR has the potential to be a valuable resource that assists with several tasks: documenting patient narratives, physical findings, and test results; using patient-specific data, medical knowledge, and computational power to support sound medical decision-making; documenting the resultant care plans and the reasoning and assessments behind them; facilitating order entry and communication with patients and other clinicians; and efficiently organizing large-volume data to enhance research and population health tracking.

Exploring Goldstein et al.’s Scalelink method of data linkage.

ObjectivesScalelink is an innovative probabilistic data linkage method based on correspondence analysis. Unlike the popular and widely-used Fellegi-Sunter algorithm, it does not assume linkage variable independence. It also claims to be more intuitive and computationally efficient. We aim to test this method for the first time on real-world big data.&#x0D; ApproachScalelink uses agreement states for each linkage variable and candidate pair. These are compared to determine how frequently, for all candidate pairs, any given agreement state is held at the same time as any other agreement state (this accounts for variable dependence). The results of this comparison are inputted into a loss function and the minimisation of this function is derived within constraints to produce weights. Currently, the method is accessible via Goldstein et al.’s paper and R package. We are translating it into PySpark to enable testing on datasets that are too large to link without using distributed computing.&#x0D; ResultsInitial testing of Goldstein et al.’s Scalelink method on small samples of real-world datasets shows that it performs as expected for a probabilistic linkage method, although cannot currently deal with missingness. To test the quality of the method on real-world big data, a high-quality linked dataset of the 2021 England and Wales Census and follow-up Census Coverage Survey will be used as a Gold Standard (GS). After developing a method that enables Scalelink to deal with missingness, we will apply Scalelink and automatic Fellegi-Sunter probabilistic linkage to this GS. We can thus establish and compare the precision and recall of both methods. We will also investigate linkage bias for particular demographics, test computational efficiency and estimate the clerical review burden for each method.&#x0D; ConclusionGoldstein et al.’s Scalelink algorithm shows promise as a high quality, scalable, dependence-free linkage algorithm for use in any matching project. Here, for the first time, we research the method’s quality and feasibility with real-world big data. From this we will produce recommendations regarding its utility.

The Wicked Problem of Physician Well-Being.

The collective threat to physician well-being is a complex issue with no clear solution. Even before the coronavirus disease 2019 pandemic, physicians suffered from widespread burnout and moral injury, with negative consequences for patient care, physician health, and the health care system. Initial clinician well-being efforts leaned heavily on individual-focused interventions. However, workplace culture and environment are key factors that affect burnout, and therefore clinician well-being efforts require both individual-focused and systems-level interventions. A sustainable culture of support in medicine is necessary to foster physician well-being.

Burnout and well-being in otolaryngology trainees: A systematic review.

ObjectiveTo comprehensively review the recent published literature to characterize current trends of burnout and well‐being among otolaryngology trainees.MethodsStudy design: systematic review and meta‐analysis. A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well‐being, as well as the general topic of well‐being among surgical residents was completed. All included studies were summarized qualitatively. For the quantitative analysis, only articles reporting a Maslach burnout inventory (MBI), modified MBI or Mini‐Z‐ Burnout assessment were included.ResultsTwenty‐five articles were included in the qualitative summary and nine articles in the quantitative analysis. In the qualitative summary, trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists. Total hours worked per week and female gender were associated with worsened well‐being. Residency program strategies to improve trainee well‐being include program‐sponsored wellness activities, dedicated wellness champions, and assistance with clerical burden. Implementation of protected nonclinical time has been shown to decrease burnout and increase well‐being among trainees. Moreover, formal trainee mentorship programs have also been shown to reduce trainee burnout and stress. In the quantitative analysis, rates of trainee burnout ranged from 29.7% to 86% with an overall trend towards reduced rates of burnout from 2006 to 2021. Utilizing a weighted average, the overall burnout among otolaryngology residents was 58.6%.ConclusionsRates of burnout remain high among otolaryngology trainees. Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well‐being.

Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States.

The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout. This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated. The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents' perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (χ2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (χ2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (χ2 = 93.082, P < 0.001) were protective against burnout. Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.

Time and Clerical Burden Posed by the Current Electronic Health Record for Orthopaedic Surgeons.

The electronic health record (EHR) has become an integral part of modern medical practice. The balance of benefit versus burden of a required EHR remains inconclusive, with many studies identifying increasing physician burnout and less face-to-face patient contact because of increasing documentation demands. Few studies have investigated EHR burden in orthopaedic surgery practice. This study aimed to characterize and compare EHR usage patterns and time allocation within EHR between orthopaedic surgeons, other surgeons, and medicine physicians at an academic medical center. EHR usage was digitally tracked within a large academic medical center. EHR usage data were compiled for all physicians seeing outpatients from April 2018 to June 2019. The tracking metrics included time spent answering messages, typing notes, reviewing laboratories and imaging, reading notes, and placing orders. Physicians were subdivided between orthopaedic surgeons, other surgeons, and nonsurgeon/medical specialties. Statistical comparisons using a two-sample t-test were done between orthopaedic surgeon EHR usage patterns and other surgeons, in addition to orthopaedic surgeons versus nonsurgeons. One thousand sixty physicians including 28 full-time orthopaedic surgeons, 134 other surgeons, and 898 nonsurgical medicine physicians met inclusion criteria. Orthopaedic surgeons saw on average 31 patients per office day compared with other surgeons at 18 patients per office day (P < 0.01) and nonsurgeons at 12 patients per office day (P < 0.01). Orthopaedic surgeons received more EHR messages while also being more efficient at answering EHR messages compared with other surgeons and nonsurgeons (P < 0.01). EHR tasks, including answering messages, placing orders, chart review, writing notes, and reviewing imaging, consumed 58% of an orthopaedic surgeon's scheduled office day with the largest contribution from required note writing. In academic orthopaedic practice, EHR use has surpassed face-to-face patient time, consuming 58% of orthopaedic surgeons' clinical days. With the previously shown correlation between EHR burden and physician burnout, targeted interventions to increase efficiency and off-load EHR burden are necessary to sustain a successful orthopaedic practice.

The Use of Medical Scribes in Primary Care Settings: A Literature Synthesis.

Background:Clerical burdens have strained primary care providers already facing a shifting health care landscape and workforce shortages. These pressures may cause burnout and job dissatisfaction, with negative implications for patient care. Medical scribes, who perform real-time electronic health record documentation, have been posited as a solution to relieve clerical burdens, thus improving provider satisfaction and other outcomes.Objective:The purpose of this study is to identify and synthesize the published research on medical scribe utilization in primary care and safety net settings.Research Design:We conducted a review of the literature to identify outcomes studies published between 2010 and 2020 assessing medical scribe utilization in primary care settings. Searches were conducted in PubMed and supplemented by a review of the gray literature. Articles for inclusion were reviewed by the study authors and synthesized based on study characteristics, medical scribe tasks, and reported outcomes.Results:We identified 21 publications for inclusion, including 5 that examined scribes in health care safety net settings. Scribe utilization was consistently reported as being associated with improved productivity and efficiency, provider experience, and documentation quality. Findings for patient experience were mixed.Conclusions:Published studies indicate scribe utilization in primary care may improve productivity, clinic and provider efficiencies, and provider experience without diminishing the patient experience. Further large-scale research is needed to validate the reliability of study findings and assess additional outcomes, including how scribes enhance providers’ ability to advance health equity.

Classification and analysis of asynchronous communication content between care team members involved in breast cancer treatment.

ObjectiveA growing research literature has highlighted the work of managing and triaging clinical messages as a major contributor to professional exhaustion and burnout. The goal of this study was to discover and quantify the distribution of message content sent among care team members treating patients with breast cancer.Materials and MethodsWe analyzed nearly two years of communication data from the electronic health record (EHR) between care team members at Vanderbilt University Medical Center. We applied natural language processing to perform sentence-level annotation into one of five information types: clinical, medical logistics, nonmedical logistics, social, and other. We combined sentence-level annotations for each respective message. We evaluated message content by team member role and clinic activity.ResultsOur dataset included 81 857 messages containing 613 877 sentences. Across all roles, 63.4% and 21.8% of messages contained logistical information and clinical information, respectively. Individuals in administrative or clinical staff roles sent 81% of all messages containing logistical information. There were 33.2% of messages sent by physicians containing clinical information—the most of any role.Discussion and ConclusionOur results demonstrate that EHR-based asynchronous communication is integral to coordinate care for patients with breast cancer. By understanding the content of messages sent by care team members, we can devise informatics initiatives to improve physicians’ clerical burden and reduce unnecessary interruptions.

Prevalence of Burnout among Physicians at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

Introduction: Physician burnout in armed forces involves emotional exhaustion, depersonalization and a sense of declined personal accomplishment. This can have an adverse effect on quality patient care, the healthcare team and can cost physician health in both in-training physicians and practicing physicians. The causative factors include excessive long work shifts, inefficient work systems and clerical burdens, professional home conflicts, lack of departmental support, limited work force and poor leadership culture. Objectives: This study aims at measuring the prevalence of burnout in physicians working in King Salman armed forces hospital Saudi Arabia and studying possible related socio-demographic variables. Methods: A cross sectional study was conducted between April and May 2015 among physicians. A self‑administered questionnaire was used that includes questions on socio demographic characteristics, sources of stress and burnout of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) in this study. Student’s T-test and chi square tests were used for analysis. Results: Majority were males 74.8% aged more than 35 years with the prevalence rate of 14.2%. The analyzed variables associated with emotional exhaustion, the following factors significantly affected the EE with P value&lt;0.05, exercise, alternate shift duty, work over load, quality of life, satisfaction with work and specialty. As for the significant factors associated with DP, shift duty, work overload, quality of life perception and specialty were found to have P value less than 0.05. Conclusion: Burnout is prevalent among physicians; we identified variables significantly associated with Emotional exhaustion (EE), Depersonalization (DP) and Personal accomplishment (PA). However, further research is recommended to study other predictors not mentioned in the current study and all health policy makers must work jointly in designing and implement effective remedial measures for physician burnout.

The impact of time spent on the electronic health record after work and of clerical work on burnout among clinical faculty.

To identify specific thresholds of daily electronic health record (EHR) time after work and daily clerical time burden associated with burnout in clinical faculty. We administered an institution-wide survey to faculty in all departments at Mount Sinai Health System from November 2018 to February 2019. The Maslach Burnout Inventory and Mayo Well-Being Index assessed burnout. Demographics, possible confounding variables, and time spent on EHR work/clerical burden were assessed. Of 4156 eligible faculty members, 1781(42.9%) participated in the survey. After adjustment for background factors, EHR frustration (odds ratio [OR]=1.64-1.66), spending >90 minutes on EHR-outside the workday by self-report (OR = 1.41-1.90) and >1 hour of self-reported clerical work/day (OR = 1.39) were associated with burnout. Reporting that one's practice unloads clerical burden (OR = 0.50-0.66) and higher resilience scores (OR = 0.77-0.84) were negatively associated with burnout.Spending >90 minutes/day on EHR-outside work (OR = 0.66-0.67) and >60 minutes/day on clerical work (OR = 0.54-0.58) was associated with decreased likelihood of satisfactory work-life integration (WLI) and professional satisfaction (PS). Greater meaning in work was associated with an increased. of achieving WLI (OR = 2.51) and PS (OR = 21.67). Results suggest there are thresholds of excessive time on the EHR-outside the workday (>90 minutes) and overall clerical tasks (>60 minutes), above which clinical faculty may be at increased risk for burnout, as well as reduced WLI and PS, independent of demographic characteristics and clinical work hours. These thresholds of EHR and clerical burden may inform interventions aimed at mitigating this burden to reduce physician burnout.

47 Increase Clinic Attendance Among Adolescents and Young Adults: A novel cost-effective method

Abstract Background Transition clinics have been introduced to address the unique needs of adolescent and young adult (AYA) populations, however clinic attendance continues to be an issue. Although poor clinic attendance among the AYA population has been well known, solutions to address this has been limited. Some factors that have been associated with missed appointments include forgetfulness, negative previous clinic experiences and clinic schedules. With widespread use of digital technologies among AYA, the application of digital solutions to increase attendance at healthcare appointments has been explored, but little is known on its effectiveness. Objectives To determine the effect of text messaging appointment reminders on uninformed no show rates in an AYA transition clinic. Uninformed no show rate was defined as an absence from clinic (not related to a medical emergency) without communication with the clinic. Design/Methods A pilot prospective cohort study with a retrospective control group was conducted in an AYA general hematology transition clinic. In order to establish the current no show rate at the clinic, a retrospective review of AYA patients who attended the clinic between April 2013-August 2015 was conducted. Thereafter, all patients who had an appointment scheduled between February 2016 and December 2017 were included in the study and received a text message reminder of their appointment 48 hours prior to their appointment. Monthly uninformed no show rates were collected, and a student’s t-test was conducted to determine if there was a significant difference in uninformed no show rates before and after the introduction of text message reminders. Results Eighty-six participants consented to participate in the study and received a text message reminder of their appointment. From April 2013- August 2015 a total of 51 clinic days with 236 appointments occurred. During this time the mean uninformed no show rate was 39.9%. SMS appointment reminders were sent from February 2016 to December 2017 for 48 clinic days for a total of 206 clinic appointments. The mean uninformed no show rate after the introduction of text message appointment reminders was 22.6%. The introduction of text messaging appointment reminders significantly (p&amp;lt;0.01) decreased uninformed no show rates by 17.3%. Conclusion Text message reminders are an effective low cost method in reminding AYA patients about their appointments. By using innovative, cost effective and practical strategies like text messaging reminders to increase clinic attendance, we not only improve the care of our patients but also reduce the financial and clerical burden to the system resulting from missed appointments.

High Volume Portal Usage Impacts Practice Resources.

Patient portals have both patient-centered benefits and substantial impacts on practices. Successful implementation of a patient portal can be achieved with a comprehensive team approach. Increased portal usage results in high-volume patient secure messaging. We describe the impact of high patient message volume on our fee-for-service academic family medicine practice. Practice adaptations are necessary to manage volume, length, and complexity of messages. Dedicated staff with specialized training to handle patient messages and ample protected time for providers are important to minimize clerical burden associated with patient portal use.

The impact of program-driven wellness initiatives on burnout and depression among surgical trainees

BackgroundThe prevalence of burnout and depression are high among surgical trainees. This study examined the impact of program-driven initiatives to improve surgical trainee wellness. MethodsA survey was administered to residents and fellows at all surgical training programs across an urban academic health system. The survey measured burnout, depressive symptoms, and perceptions of program-driven wellness initiatives. ResultsThe response rate was 44% among 369 residents. Of these, 63.2% screened positively for burnout, and 36.7% for depression. Residents who were burned out were more likely to work >80 h per week, have greater clerical duties, and miss educational activities more frequently. Conversely, having opportunities for wellness activities, dedicated faculty and housestaff wellness champions, and assistance with clerical burden were all associated with lower rates of burnout and depression. ConclusionThe presence of wellness support was associated with better outcomes, suggesting the value of initiatives to manage workload and support the well-being of surgical resident physicians.