Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department

Abstract

Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician's efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor-patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p< 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics.

Clinical scribes and their association with patient experience in the otolaryngology clinic

“…Although patients have reported positive attitudes toward scribes and perceived improvement of provider-patient interactions, [10][11][12] no studies have found a quantitative difference in patient's satisfaction with providers. 11,[13][14][15][16][17] Conclusions are further limited by heterogeneity in the methodology for assessing patient satisfaction in all of these studies, including many studies that created their own surveys and metrics.…”

“…7,16,19 Multiple studies have reported reduced documentation time. 14,16,19 There has been mixed evidence on the timeliness of note and chart completion in the setting of outpatient scribe utilization. 13,17 Several studies have reported an increase in time spent in direct patient care when scribes were present.…”

“…13,17 Several studies have reported an increase in time spent in direct patient care when scribes were present. 16,19 The hypothesis of this study was that presence of a scribe would positively impact patient satisfaction with their visit in the otolaryngology outpatient clinic. This was based on evidence and anecdotal experience that a scribe decreases the physician's need to rely on the computer, decreases time that the physician spends typing during the encounter, allows for increased eye contact and human interaction, and does not negatively impact the physician-patient relationship.…”

The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine

“…Medical scribes are playing an increasingly important part in improving the efficiency of physicians, particularly in the USA but also elsewhere [1,2]. Their use is being evaluated in many settings: Emergency Departments (EDs) [3][4][5][6][7][8][9][10][11], consultant offices [12][13][14][15], primary care [16,17] and hospital wards [1]. Medical scribes have been found to improve physician productivity [3,4,[8][9][10]12] in most Emergency studies, but not all [5,15].…”

“…Their aim has been to reduce the time a physician spends documenting consultations into electronic medical records (EMRs). We know that scribes are well tolerated by patients [11,14,17,18] and physicians [14,17,19] and how to train scribes [2,20,21]. We don't have a good understanding of the quality of the scribed documentation.…”