Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial

Abstract

PURPOSE Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency. METHODSWe conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close. RESULTSScribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P = .028).CONCLUSIONS To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout.

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

“…20 The others were a quality improvement study not designed to create generalizable knowledge 18 and a research study that measured satisfaction with documentation time as a proxy for documentation time. 19 Thus, the impact of medical scribes on PCP productivity remains unclear.…”

“…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.…”

One Year of Family Physicians' Observations on Working with Medical Scribes

“…13 Physicians were assigned a schedule of 1 week practicing with a scribe alternating with 1 week without a scribe. During the weeks when the physician was assigned a scribe, the scribe attended all patient encounters alongside the physician and drafted all relevant documentation, including the patient history, objective examination findings, assessment and plan, and patient instructions.…”

Impact of Scribes on Medical Student Education:

“…6,7 Recently, a randomized controlled trial of scribes found improvements in charting efficiency, overall physician satisfaction, and satisfaction with chart quality and accuracy. 8 Scribes could be especially valuable for academic physicians, whose teaching duties present an additional time burden on top of charting. While teaching students is enriching and enjoyable to many academic physicians, it can also result in higher stress and longer office days, cutting into both patient care time and personal time.…”