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.

Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort

“…21 Indeed, the only study examining time spent facing the patient, conducted in a cardiology clinic, found that providers spent more time facing the patient. 16 Data regarding the impact on patient satisfaction are more mixed, with some studies reporting improvement in patient satisfaction 22 , some reporting no change on all or most measures 17,19,23 , and some reporting reductions. 20 Only 2 of these studies were conducted in primary care 19,20 , of which 1 reported a high degree of comfort with scribes.…”

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

“…Since publication of those reviews, there have been several additional studies related to the effect of scribes on patient satisfaction. Although patients have reported positive attitudes toward scribes and perceived improvement of provider–patient interactions, no studies have found a quantitative difference in patient's satisfaction with providers . 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.…”

“…Several studies have analyzed the effects of scribes on productivity in the outpatient setting, and they have been consistently positive. Total work relative value units, a measure of physician productivity used to determine Medicare reimbursement, increased after implementation of a scribe program . Other studies have found decreased visit length and a resulting increase in the number of patients seen per hour and per day .…”

“…Total work relative value units, a measure of physician productivity used to determine Medicare reimbursement, increased after implementation of a scribe program . Other studies have found decreased visit length and a resulting increase in the number of patients seen per hour and per day . Multiple studies have reported reduced documentation time .…”

“…Other studies have found decreased visit length and a resulting increase in the number of patients seen per hour and per day . Multiple studies have reported reduced documentation time . There has been mixed evidence on the timeliness of note and chart completion in the setting of outpatient scribe utilization .…”