Improve Physician Satisfaction Research Articles

Survey of Palliative Care Use in Primary Malignant Bone Tumors: A National Cancer Database Review.

Background/Objectives: Palliative care (PC) has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Design/Setting and Subjects: Patients diagnosed with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma) between 2004 and 2018 were identified in the National Cancer Database. Cross tabulations with chi-square analysis were performed to evaluate frequencies of PC use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of PC. Results: Around 24,401 patients were identified. Overall, 2.52% had any form of PC utilization. Of those receiving PC, 55.5-65.1% were treated with only noncurative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of PC utilization were decreased for patients with chordomas, patients living >24 miles from the treatment facility, or patients with private insurance, Medicare, or unknown insurance status. Odds of PC utilization were increased in patients with greater tumor diameter or unknown tumor size, tumors in midline, increased tumor grade, stage IV tumors, or living in urban areas. Conclusion: PC use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, and if the tumor is midline, and in patients living in urban areas. However, overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of PC.

Improving the discharge medication reconciliation process for an inpatient hematologic malignancies service by utilizing a pharmacist-facilitated workflow

BackgroundThere is an opportunity for pharmacists to play a greater role during discharge medication reconciliation (MR), particularly in the oncology setting. ObjectivesThis initiative aims to decrease the number of medication discrepancies that occur during discharge MR and improve physician satisfaction with the discharge MR process for patients discharged from an inpatient adult hematologic malignancies (HM) service. Practice descriptionPatients on the HM service at Sibley Memorial Hospital, a community hospital located in Washington, DC, are co-managed by hospitalists and HM oncologists. The care team for the service also includes nursing staff and a clinical pharmacist. Practice innovationThe HM service piloted a pharmacist-facilitated workflow that involved the clinical pharmacist reconciling inpatient and outpatient medications prior to discharge, reviewing the discharge MR with the HM oncologist, and pending the discharge MR in the electronic medical record for the discharging hospitalist to review and sign. Evaluation methodsPrior to pilot implementation, discharge MRs of patients discharged from the HM service from November 2021 to December 2021 were analyzed by a pharmacist to identify medication discrepancies through retrospective chart review. This process was repeated to analyze pharmacist-facilitated discharge MRs for discrepancies for patients discharged between December 2021 to April 2022. Physician satisfaction with the process was assessed via survey pre and post-pilot. ResultsA total of 30 and 37 discharge MRs were analyzed pre- and post-pilot, respectively. There were 19 medications discrepancies identified in the pre-pilot group and 6 discrepancies noted in the post-pilot group (P=0.038). Median physician satisfaction with the process was found to be 3.3 pre-pilot, and 5 post-pilot (on a scale of 1-5, with 5 being very satisfied). ConclusionA pharmacist-facilitated workflow for discharge MR increased the accuracy of the discharge MR for patients on the HM service and improved physician satisfaction with the discharge MR process.

Survey of palliative care use in primary malignant bone tumors: An NCDB review.

e23514 Background: Palliative care has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Methods: This study retrospectively evaluated the use of palliative care in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma & chordoma) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2018. Patients were identified by ICD-O-3 coding and patients with other malignancies were excluded. Cross Tabulations with Chi-square analysis was performed to evaluate frequencies of different patient and tumor characteristics. Multivariable logistic binary logistic regression was performed to evaluate relationships between patient and tumor characteristics and the use of palliative care. Results: 24,401 patients with primary malignant bone tumors were identified. Overall, only 2.52% had any form of palliative care utilization. Of those receiving palliative care, 55.5-65.1% were treated with only non-curative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of palliative care were decreased for patients with chordomas, patients living more than 24 miles from the treatment facility, patients living in west-south-central or pacific states, or patients with private insurance, medicare, or unknown insurance status. Odds of palliative care were increased in patients with greater tumor diameter or unknown tumor size, tumors in the midline, increased tumor grade, stage 4 tumors, or patients living in urban areas. Conclusions: Palliative care use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, midline tumors, or in patients living in urban areas, but overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of palliative care.

Saving Time for Patient Care by Optimizing Physician Note Templates: A Pilot Study.

Background: At times, electronic medical records (EMRs) have proven to be less than optimal, causing longer hours behind computers, shorter time with patients, suboptimal patient safety, provider dissatisfaction, and physician burnout. These concerning healthcare issues can be positively affected by optimizing EMR usability, which in turn would lead to substantial benefits to healthcare professionals such as increased healthcare professional productivity, efficiency, quality, and accuracy. Documentation issues, such as non-standardization of physician note templates and tedious, time-consuming notes in our mother-baby unit (MBU), were discussed during meetings with stakeholders in the MBU and our hospital's EMR analysts.Objective: The objective of this study was to assess physician note optimization on saving time for patient care and improving provider satisfaction.Methods: This quality improvement pilot investigation was conducted in our MBU where four note templates were optimized: History and Physical (H and P), Progress Note (PN), Discharge Summary (DCS), and Hand-Off List (HOL). Free text elements documented elsewhere in the EMR (e.g., delivery information, maternal data, lab result, etc.) were identified and replaced with dynamic links that automatically populate the note with these data. Discrete data pick lists replaced necessary elements that were previously free texts. The new note templates were given new names for ease of accessibility. Ten randomly chosen pediatric residents completed both the old and new note templates for the same control newborn encounter during a period of one year. Time spent and number of actions taken (clicks, keystrokes, transitions, and mouse-keyboard switches) to complete these notes were recorded. Surveys were sent to MBU providers regarding overall satisfaction with the new note templates.Results: The ten residents' average time saved was 23 min per infant. Reflecting this saved time on the number of infants admitted to our MBU between January 2016 and September, 2019 which was 9373 infants; resulted in 2.6 hours saved per day, knowing that every infant averages two days length of stay. The new note templates required 69 fewer actions taken than the old ones (H and P: 11, PN: 8, DCS: 18, HOL: 32). The provider surveys were consistent with improved provider satisfaction.Conclusion: Optimizing physician notes saved time for patient care and improved physician satisfaction.

The Optimization between Physician Satisfaction and Hospital Profit in Cross-Hospital Scheduling-A Case Study of Some Hospitals in Taiwan.

In recent years, the majority of the population has preferred to go to large hospitals regardless of the severity of their illnesses, resulting in a waste of medical resources. In view of this situation, the government has proposed a cross-hospital integration plan to promote the integration of medical resources. Hospitals that provide support can not only increase their income but also extend their medical coverage to other regions and get wide access to more patients. While previous studies mainly focused on the internal shift scheduling of hospitals, this study took into account both the internal hospital and the support to branch hospitals and particularly explored the financial benefits generated by the provision of support and the satisfaction of physicians on shift scheduling. Decision makers can give different weight values according to the management needs and then determine the most appropriate physician shift schedule according to the final decision value. The shift-schedule-building system developed in this study could be used to quickly calculate the most appropriate shift schedule according to the actual needs, which could replace the time-consuming method of manual scheduling and improve physician satisfaction and hospital financial income.

Randomized trial of community health worker-led decision coaching to promote shared decision-making for prostate cancer screening among Black male patients and their providers

BackgroundBlack men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality.MethodsWe proposed a CHW-led decision-coaching program to facilitate SDM for prostate cancer screening discussions in Black men at a primary care FQHC. This study enrolled Black men who were patients at the participating clinical site and up to 15 providers who cared for them. We estimated to recruit 228 participants, ages 40–69 to be randomized to either (1) a decision aid along with decision coaching on PSA screening from a CHW or (2) receiving a decision aid along with CHW-led interaction on modifying dietary and lifestyle to serve as an attention control. The independent randomization process was implemented within each provider and we controlled for age by dividing patients into two strata: 40–54 years and 55–69 years. This sample size sufficiently powered the detection differences in the primary study outcomes: knowledge, indicative of decision quality, and differences in PSA screening rates.Primary outcome measures for patients will be decision quality and decision regarding whether to undergo PSA screening. Primary outcome measures for providers will be acceptability and feasibility of the intervention. We will examine how decision coaching about prostate cancer screening impact patient-provider communication. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured, in-depth interviews, and thematic analysis of clinical encounters. Through a conceptual model combining elements of the Preventative Health Care Model (PHM) and Informed Decision-Making Model, we hypothesize that the prostate cancer screening decision coaching intervention will result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction with counseling patients about prostate cancer screening.DiscussionDecision coaching is an evidence-based approach to improve decision quality in many clinical contexts, but its efficacy is incompletely explored for PSA screening among Black men in primary care. Our proposal to evaluate a CHW-led decision-coaching program for PSA screening has high potential for scalability and public health impact. Our results will determine the efficacy, cost-effectiveness, and sustainability of a CHW intervention in a community clinic setting in order to inform subsequent widespread dissemination, a critical research area highlighted by USPSTF.Trial registrationThe trial was registered prospectively with the National Institute of Health registry (www.clinicaltrials.gov), registration number NCT03726320, on October 31, 2018.

Nurse anesthetist training Center on IFNA standards in Mainland China

AimThe first training center for nurse anesthetists in Jiangsu Province, China was established. The aim of this study is to understand the status of and effectiveness of a training program based on International Federation of Nurse Anesthetists (IFNA) standards for nurse anesthetists in China. BackgroundChina recently issued a clear policy to improve the quality of anesthesia care and to ensure the safety and comfort of patients. As a result, the roles of nurse anesthetists have received more attention, highlighting the importance of the development and implementation of relevant training. IntroductionIFNA standards were applied to the development of a specialized training program for nurse anesthetists, which is expected to serve as a reference for various medical institutions and to lead to increased uniformity and improvement in the quality and efficiency of care. MethodsThese standards are divided into two indicators: curriculum and core competencies. Through questionnaires, course evaluations, and satisfaction surveys before and after the implementation of the training program, the effectiveness of the training program was analyzed. ResultsTheoretical assessment of the program was higher after its completion than before and the core competencies of nurse anesthetists significantly improved. Overall, the curriculum was highly satisfactory and important. DiscussionCurriculum design was based on IFNA standards. Nurse anesthetists who are trained in a systematic way can work better with other professionals in providing anesthesia care. The objectives are to improve anesthesia care, reduce errors, improve physician satisfaction, and allow nurse anesthetists to realize their value. Overall, quality of anesthesia care improved after implementation of IFNA-standard training.

326 Does a Physician Developed Airway Equipment Tray Improve Physician Satisfaction and Speed of Intubation Preparation?

326 Does a Physician Developed Airway Equipment Tray Improve Physician Satisfaction and Speed of Intubation Preparation?

Impact of a specialty trained billing team on an academic otolaryngology practice

To determine how the incorporation of specialty specific training for coders within a focused billing team affected revenue, efficiency, time to reimbursement, and physician satisfaction in an academic otolaryngology practice. Our academic otolaryngology department recently implemented a new billing system, which incorporated additional training in otolaryngology surgical procedures for medical coders. A mixed model analysis of variance was used to compare billing outcomes for the 6months before and 6months after this new approach was initiated. The following metrics were analyzed: Current Procedural Terminology codes, total charges, time between services rendered and billing submission, and time to reimbursement. A survey of department physicians assessing satisfaction with the system was reviewed. There were 4087 Current Procedural Terminology codes included in the analysis. In comparing the periods before and after implementation of the new system, statistically significant decreases were found in the mean number of days to coding completion (19.3 to 12.0, respectively, p<0.001), days to posting of charges (27.0 to 15.2, p<0.001), days to final reimbursement (54.5 to 27.2, p<0.001), and days to closure of form (179.2 to 76.6, p<0.001). Physician satisfaction with communication and coder feedback increased from 36% to 64% after initiation of the new program. The implementation of additional specialty training for medical coders in the otolaryngology department of a large medical system was associated with improved revenue cycle efficiency. Additionally, this model appears to improve physician satisfaction and confidence with the coding system.

The Positive Impact of Establishing an Internal Transfer Center

Health systems are facing greater pressures than ever before, with factors ranging from mergers and acquisitions and changing reimbursement models to capacity challenges and staffing shortages. A transfer center, where with 1 simple call from a referring physician, a decision to accept a critically ill patient can be made, placing them at the most appropriate level of care, the first time. Baptist Health in Jacksonville, Florida, went from an outsourced to an in-house center in 3 months—in the first 28 days alone, patient transfers increased from 900 to 1,500, growing to an average of 1,583 transfers per month.

Financial considerations in outpatient spine surgery

This paper aims to review the cost benefits of performing spine surgeries at an ambulatory surgery center or an outpatient hospital department. The potential for cost savings associated with ambulatory based surgery centers or outpatient hospital departments will likely continue to increase the number of spine surgeries performed at such locations. Several types of ownership structures for ambulatory based surgery centers or outpatients hospital departments exist, and can be broadly categorized into sole physician ownership, sole hospital ownership, physician-hospital joint ownership, physician-management service joint ventures. It can be argued that a sole physician ownership of these centers can cause potential conflicts of interests; however, it can also decrease costs for patients and improve physician satisfaction.

Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care.

Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic. Prospective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction. Six GIM faculty and a convenience sample of their patients (N = 325) at an academic GIM clinic. A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe. Of six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76h per clinic session (p = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present (p = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe (p = 0.03). In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.

A Systematic Review of Interventions to Follow-Up Test Results Pending at Discharge.

Patients are frequently discharged from the hospital before all test results have been finalized. Thirty to 40% of tests pending at discharge (TPADs) return potentially actionable results that could necessitate change in the patients' management, often unbeknownst to their physicians. Delayed follow-up of TPADs can lead to patient harm. We sought to synthesize the existing literature on interventions intended to improve the management of TPADs, including interventions designed to enhance documentation of TPADs, increase physician awareness when TPAD results finalize post-discharge, decrease adverse events related to missed TPADs, and increase physician satisfaction with TPAD management. We searched Medline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Database of Controlled Clinical Trials and Medline (January 1, 2000-November 10, 2016) for randomized controlled trials and prospective, controlled observational studies that evaluated interventions to improve follow-up of TPADs for adult patients discharged from acute care hospitals or emergency department settings. From each study we extracted characteristics of the intervention being evaluated and its impact on TPAD management. Nine studies met the criteria for inclusion. Six studies evaluated electronic discharge summary templates with a designated field for documenting TPADs, and three of six of these studies reported a significant improvement in documentation of TPADs in discharge summaries in pre- and post-intervention analysis. One study reported that auditing discharge summaries and providing feedback to physicians were associated with improved TPAD documentation in discharge summaries. Two studies found that email alerts when TPADs were finalized improved physicians' awareness of the results and documentation of their follow-up actions. Of the four studies that assessed patient morbidity, two showed a positive effect; however, none specifically measured the impact of their interventions on downstream patient harm due to delayed follow-up of TPADs. Three studies surveyed physicians' attitudes towards the interventions, of which two studies reported improved physician satisfaction with TPAD management with the implementation of an enhanced discharge template and a notification system when TPADs finalize. Discharge summary templates, educational interventions for discharging physicians, and email alerts when TPAD results are finalized show promise in improving management of TPADs. Given the complexity of the processes necessary to ensure follow-up of TPADs, rigorous evaluations of multifaceted interventions (e.g., improved discharge documentation of TPADs combined with email alerts when results become available) is needed.

Multiple Identities: A Literature Review on the Unique Experiences and Challenges of LGBT Female Physicians of Color

Lesbian, gay, bisexual, and transgender (LGBT) female physicians of color experience an interesting intersectionality of identities. While socially advantaged due to their status as physicians, they are also struck with socially disadvantageous statuses by being female, person of color, and LGBT. These individuals are united by recurring themes of oppression, lack of visibility, perceived inferiority, and of course empowerment. The purpose of this paper is to review the current literature on LGBT female physicians of color and to provide a framework for potential solutions. By increasing the number of LGBT female physicians of color in both the general workforce and positions of leadership, the patient-physician relationship can be strengthened, improving healthcare outcomes for the underserved. Further, improved physician satisfaction will promote physician wellbeing and longevity and protect against physician burnout.

Saturday Switch: An Intervention to Improve Physician Satisfaction

Saturday Switch: An Intervention to Improve Physician Satisfaction

Board Work Groups on Innovation, Wellness Have Synergistic Missions

Board Work Groups on Innovation, Wellness Have Synergistic Missions

Can Use of Medical Scribes Bring Efficiency in a Busy GI Lab?

Introduction: Electronic Medical Record (EMR) Systems markedly improve the quality and productivity of clinicians in the Healthcare system, however the use of EMR can be burdensome and decrease the physician engagement to the patient. In recent years use of medical scribes has been studied in the hospital setting and has been shown to improve physician satisfaction and increase revenues and productivity. The purpose of this study is to evaluate if use of a medical scribe in a GI lab can increase productivity and time-related efficiencies. Methods: Retrospective chart review was conducted on all the upper GI endoscopies and colonoscopies done in the last 12 months in a tertiary care hospital. Pre-operative (Preop), time in room, procedure time and recovery time was calculated on each procedure. These times were then compared between the providers who worked with a scribe and those who did not. Results: 866 procedures were done by the providers without using a medical scribe and 278 were done with the use of medical scribe. Mean preop time for procedures with a scribe was 40.94 min compared to 45.60 min without the use of scribe. Similarly, differences were seen in time in room (25.20 min vs 33.46 min, P=0.06) and procedure time (10.99 min vs 22.07 min, P=0.05) among the two groups showing the use of a medical scribe is time-efficient. The recovery time of patients was greater in procedures in which a medical scribe was utilized, but the results were not statistically significant. Secondly, the medical scribe has no impact on recovery time.Table: Table. Mean times in each interval for patients without a scribe and those with a scribeConclusion: Studies in the past discussed the use of medical scribes in emergency settings, clinic settings, and cardiology and urology clinics. As per literature review, this is the first study done on the utilization of medical scribes in the GI lab. Given increasing workload of both screening and emergent procedures on gastroenterologists, the use of medical scribes can increase physician satisfaction, productivity and most importantly can increase hospital revenue by having more procedures done in same duration of time.

Liver Imaging Reporting and Data System Classification of Hepatocellular Carcinoma: Implications for Clinical Management

AbstractAs the incidence of hepatocellular carcinoma (HCC) continues to increase worldwide, the role imaging plays in management continues to gain clinical importance. Multiple entry points exist for patients in the scheme of diagnosis and treatment of HCC and non-HCC malignancies. Further complicating this scheme is the lack of standardization in the language used for diagnostic imaging and management recommendations. The Liver Imaging Reporting and Data System (LI-RADS) was created to improve communication between clinicians and management teams. LI-RADS serves to standardize reports, improving physician satisfaction and aiding in management decisions across the continuum of care of these patients. Furthermore, LI-RADS provides technical specifications across multiple imaging modalities for screening and follow-up examinations, with the end goal of curing the disease or prolonging survival. In this review, the LI-RADS algorithm will be expanded upon, as well as its utility for various treatment options using the standardized LI-RADS lexicon. Additionally, pitfalls and non-HCC malignancies will also be addressed with resultant improvement in reproducibility of radiology reports that guide therapeutic management.

Is there a doctor in the house? Availability of Israeli physicians to the workforce

BackgroundIsraeli policymakers have expressed serious concerns about being able to meet the growing demand for physician services. For this reason, the Israel Ministry of Health (MoH) undertook studies based on 2008 and then 2012 data to obtain an accurate assessment of the size, specialty mix, demographic and geographic composition of the physician workforce. This paper highlights the findings from these studies about the number and percentage of licensed physicians in Israel who were not available, were only partially available, or were about to leave the Israeli healthcare workforce.MethodsThe two studies cross-linked administrative files of the entire physician population in Israel. The two sources were the MoH registry of licensed physicians, which contains demographic, medical education and specialty information, and the Israel Tax Authority income file on employment data. A third source, used only for the study of 2008 data, was the CBS Population Census Data 2008 which was based on a large representative sample of the population (14%), along with the updated Population Registry, which provided data on physicians whose occupation was in medical care as well as the number of work-hours. By linking the files we could also assess the population of licensed Israeli physicians living abroad.ResultsOnly 74% of licensed physicians of all ages in 2012 were active in the Israeli workforce. Of physicians under the age of 70, 87% were living and working in Israel. Female physicians tended to retire from the workforce earlier than males and were more likely to work fewer hours during their working years. The rate of physicians who worked longer hours declined in both genders as age rose. About 10% of licensees had been living abroad for at least a year and the majority of these were older. Approximately 7% of licensed physicians, ages 30–44, were abroad and most are presumed to be doing additional clinical training or gaining research experience.In some specialty fields young physicians were not replacing retirees at a compensatory rate; anesthesiologists, a specialty in short supply in Israel were more likely to be living abroad than other specialists.ConclusionsAssessment of the medical workforce pool and personnel planning require not just the number of licensed physicians but also information about the employment mix of license holders and their level of professional activity in Israel.For planning future workforce needs, it is important to keep in mind that the average female vs. male physician has lower clinical productivity due to shorter hours and earlier retirement and that a group of young physicians will predictably be abroad at any point in time; however major “brain drain” is not evident. Furthermore, extrapolating from the findings in the current studies, we believe that a potential shortage of physicians within Israel can be mitigated by better administrative support of physicians, use of physician extenders, and careful attention to improving physician satisfaction in certain specialties.

Transforming Nephrology.

Transforming Nephrology.