Faculty Bibliography

STUDY OBJECTIVE/OBJECTIVE:Housing instability is prevalent among emergency department (ED) patients and is known to adversely affect health. We aim to determine the incidence and timing of homeless shelter entry after an ED visit among patients who are not currently homeless. METHODS:We conducted a random-sample survey of ED patients at an urban public hospital from November 2016 to September 2017. Patients provided identifying information and gave informed consent for us to link their survey data with the New York City Department of Homeless Services shelter database. Shelter use was followed prospectively for 12 months after the baseline ED visit. We examined timing of shelter entry in the 12 months after the ED visit, excluding patients who were homeless at baseline. RESULTS:Of 1,929 unique study participants who were not currently homeless, 96 (5.0%) entered a shelter within 12 months of their baseline ED visit. Much of the shelter entry occurred in the first month after the ED visit, with continued yet slower rates of entry in subsequent months. Patients in our sample who entered a shelter were predominantly men and non-Hispanic black, and commonly had past shelter and frequent ED use. CONCLUSION/CONCLUSIONS:In this single-center study, 5.0% of urban ED patients who were not currently homeless entered a homeless shelter within the year after their ED visit. Particularly if replicated elsewhere, this finding suggests that ED patients may benefit from efforts to identify housing instability and direct them to homelessness prevention programs.

Background: The work of ED physicians is complex, with increasing patient volumes, rapidly changing EHRs, and growing documentation regulations. Medical scribes aim to address these problems, workflow efficiency, job satisfaction, and increase reimbursements. Despite the advantages, facilities remain resistant to adopting a scribe program for several reasons, including cost, addition of ED personnel, and incorporation new roles within an established workflow. Looking to minimize challenges, we propose modified telescribes utilizing a pre-established, qualified volunteer program. Workflow consists of providers connecting to telescribes via audio/video from secure mobile devices. Proper consent is obtained and telescribes document patient interactions in real time. Providers reap benefits of note drafting and volunteers gain valuable education only obtainable through collaboration with ED providers. Objectives: Assess physician, hospital volunteer, and patient receptiveness to scribes and telescribes. Methods: A survey was sent to 88 attendings (RR=29%) and 59 residents (RR=39%) employing yes/ no, multiple choice, and Likert scale questions to assess receptivity to scribes and telescribes; no supplemental information. A second survey evaluated hospital volunteers' desire to participate (n=50; RR=44%). A third survey (n=12) gauged patient responses to both scribes and telescribes services using a likert scale after a brief explanation of the services. Results: Of providers surveyed, 84% never used a traditional scribe or telescribe, while 85% indicated a desire to work with them. Furthermore, 95% agreed that learning to use a scribe would benefit them in the future and 75% agreed to adjust workflow to accommodate a scribe. Despite willingness to use a traditional scribe, 45% indicated they would not use the telescribe service (free-text rationales related to inconvenience). Secondly, 95% hospital volunteer respondents were interested in the scribe position. Finally, a patient survey showed zero were uncomfortable with presence of a scribe and 16% and 25% were uncomfortable with an audio or video scribe, respectively. Conclusion: Our results indicate patients and providers are more comfortable with a traditional scribe model and implementation of a telescribe model requires addressing workflow and privacy concerns of provider and patient

BACKGROUND: Mobile devices have been shown to assist patients with comprehension of health information, yet sparse data exist on what mobile devices patients own and preferences for receiving health information. OBJECTIVES: To determine the prevalence of mobile devices capable of receiving health information among patients/visitors presenting to an urban Emergency Department (ED). METHODS: A random sample of patients/visitors >/=18 years was surveyed. The primary outcome was prevalence of mobile devices capable of receiving health information among patient/visitor units presenting to the ED. Means and 95% confidence intervals were derived for continuous data; proportions with Fisher's exact 95% confidence intervals were derived for categorical data. Institutional review board approval was received before study initiation. RESULTS: Surveyors approached 1307 subjects: 68% (885) were eligible; 70% (620) agreed to participate; 4 participants were excluded, leaving 70% (616) in the final sample. Of the 616 participants, 82% stated cell phone ownership (95% confidence interval [CI] 0.79-0.85). Among cell phone owners (n = 507), 90% had the device with them (95% CI 0.87-0.92) in the ED. Of these participants (n = 456), 77% had text messaging (95% CI 0.73-0.81), 51% had Internet (95% CI 0.47-0.56), 51% had e-mail (95% CI 0.46-0.56), 39% could download audio content (95% CI 0.34-0.43), and 35% could download videos (95% CI 0.31-0.40). Even among those having an annual income