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Objectives: Medical scribes may offer a route to improve physician productivity and workflow efficiency with reduced physician time for documentation. To our knowledge, there is no prior literature on medical scribe impact on outpatient pediatric gastroenterology clinic operations. The primary aim of our study was to address this knowledge gap. Methods: Data were collected on encounters conducted by pediatric gastroenterology physicians at a tertiary center, during a summer scribe program. Scribes were trained and attended clinics in a nonrandomized fashion. Clinic efficiency was assessed by patient flow, tracked via the electronic medical record system. Medical note complexity codes, associated work relative value units (wRVUs), and note delinquency were compared between encounters with and without scribes. Patient satisfaction survey scores were compared between groups. Results: One thousand nine hundred seventy encounters were included. Documented medical note complexity (and wRVUs), note delinquency, patient satisfaction, and perceived overall quality of service were similar between groups. Clinic time for established encounters was statistically shorter with scribes (median 18 vs 21 minutes, P = 0.01), a 14% reduction. No significant difference was noted in new encounter clinic time. The time to note completion was shorter for new encounters with scribes (2 vs 3 days, P = 0.048). More notes were finalized by the third day postencounter when a scribe was present (63% vs 57%, P = 0.02). Conclusions: The presence of medical scribes was associated with significantly more efficient clinic flow for established encounters and modest improvements in note completion rate. There were no measurable negative effects on documented medical note complexity or patient satisfaction scores.

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INTRODUCTION: The aim of the current study is to develop and validate a prediction model for postpartum hemorrhage (PPH) based on antenatal and intrapartum risk factors in a diverse patient population at a tertiary safety-net center. METHODS: In this observational cohort of 10,025 pregnant women who delivered at Denver Health Medical Center (DHMC) between April, 2016 and March, 2019, ante- and intrapartum characteristics were compared between women with PPH and those without. A predictive multivariable model was estimated using logistic regression with a backwards stepwise approach eliminating variables when P>.05 among the prediction cohort of women delivering before April 2018. The model was validated among women, who delivered after April, 2018. RESULTS: A total of 9,774 women met inclusion criteria, 6,525 in the prediction cohort and 3,249 in the validation cohort. The prevalence of PPH in the prediction and validation cohorts was 6.1% and 6.8%, respectively. Maternal age, maternal body mass index (BMI, kg/m2), parity, gestational age, history of prior cesarean, history of PPH, abnormal placentation, neonatal weight, chorioamnionitis, platelet count on admission and intrapartum magnesium administration were included in the final prediction model. The area under the curve (AUC) for the prediction model was 0.81 (95% CI 0.79-0.84) and the AUC for the validation cohort was 0.89 (95% CI 0.86-0.91). CONCLUSION: The model performed well and can be used to identify women at risk for PPH. Further studies are necessary to evaluate the effect of the model use on decreasing PPH and associated maternal morbidity.

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