Time Motion Analysis: Impact of Scribes on Provider Time Management

Heaton, Heather A.; Wang, Rona; Farrell, Kyle; Ruelas, Octavia S.; Goyal, Deepi G.; Lohse, Christine M.; Sadosty, Annie T.; Nestler, David M.

doi:10.1016/j.jemermed.2018.04.018

Cited by 16 publications

(28 citation statements)

References 16 publications

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“…Half of all included studies (50%, n ¼ 9) were time motion or work sampling studies with direct observation techniques. [42][43][44][45][46][47][48][49][50] Other study designs were retrospective cohort and cross-sectional studies (44%, n ¼ 8) [51][52][53][54][55][56][57][58] and one descriptive qualitative study (6%, n ¼ 1). 59 Of conducted studies, 17 were done in the United States, [42][43][44][45][46][47][48][49][51][52][53][54][55][56][57][58][59] and one in Argentina.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Interaction Time with Electronic Health Records: A Systematic Review

et al. 2021

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Background The amount of time that health care clinicians (physicians and nurses) spend interacting with the electronic health record is not well understood. Objective This study aimed to evaluate the time that health care providers spend interacting with electronic health records (EHR). Methods Data are retrieved from Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily, (Ovid) Embase, CINAHL, and SCOPUS. Study Eligibility Criteria Peer-reviewed studies that describe the use of EHR and include measurement of time either in hours, minutes, or in the percentage of a clinician's workday. Papers were written in English and published between 1990 and 2021. Participants All physicians and nurses involved in inpatient and outpatient settings. Study Appraisal and Synthesis Methods A narrative synthesis of the results, providing summaries of interaction time with EHR. The studies were rated according to Quality Assessment Tool for Studies with Diverse Designs. Results Out of 5,133 de-duplicated references identified through database searching, 18 met inclusion criteria. Most were time-motion studies (50%) that followed by logged-based analysis (44%). Most were conducted in the United States (94%) and examined a clinician workflow in the inpatient settings (83%). The average time was nearly 37% of time of their workday by physicians in both inpatient and outpatient settings and 22% of the workday by nurses in inpatient settings. The studies showed methodological heterogeneity. Conclusion This systematic review evaluates the time that health care providers spend interacting with EHR. Interaction time with EHR varies depending on clinicians' roles and clinical settings, computer systems, and users' experience. The average time spent by physicians on EHR exceeded one-third of their workday. The finding is a possible indicator that the EHR has room for usability, functionality improvement, and workflow optimization.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Interaction Time with Electronic Health Records: A Systematic Review

et al. 2021

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“…1 However, time spent documenting the patient encounter and performing other clerical tasks can reduce the time available to spend with patients, which can lead to less efficient care. [2][3][4] Physicians have also reported lower satisfaction with documentation and computerized physician order entry, which can lead to increased stress and burnout. [5][6][7] To mitigate these challenges, medical scribes have been proposed as an approach to reduce the burden on physicians for mechanical data entry and documentation while increasing efficiency of care.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Effect of Medical Scribes on Throughput, Revenue, and Patient and Provider Satisfaction: A Systematic Review and Meta-analysis

Gottlieb

Palter

Westrick

et al. 2021

Annals of Emergency Medicine

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Study objective: Documentation in the medical record increases clerical burden to clinicians and reduces time available to spend with patients, thereby leading to less efficient care and increased clinician stress. Scribes have been proposed as one approach to reduce this burden on clinicians and improve efficiency. The primary objective of this study is to assess the effect of scribes on throughput, revenue, provider satisfaction, and patient satisfaction in both the emergency department (ED) and non-ED setting.Methods: PubMed, Scopus, the Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature database, Google Scholar, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched for studies assessing the effect of scribes versus no scribes on the following outcomes: patients per hour, relative value units (RVUs) per hour, RVUs per encounter, clinic length of stay, time to disposition, ED length of stay, ED length of stay for admitted patients, ED length of stay for discharged patients, provider satisfaction, and patient satisfaction. Data were dual extracted into a predefined work sheet, and quality analysis was performed with the Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Subgroup analyses were planned between ED versus non-ED studies. Results:We identified 39 studies comprising greater than 562,682 patient encounters. Scribes increased patients treated per hour by 0.30 (95% confidence interval [CI] 0.10 to 0.51). Scribes increased RVUs per encounter by 0.14 (95% CI 0.03 to 0.24) and RVUs per hour by 0.55 (0.30 to 0.80). There was no difference in time to disposition (5.74 minutes; 95% CI -2.63 to 14.10 minutes) or ED length of stay (-3.44 minutes; 95% CI -7.68 to 0.81 minutes), although a difference was found in clinic length of stay (5.74 minutes; 95% CI 0.42 to 11.05 minutes). Fourteen of 16 studies reported favorable provider satisfaction with a scribe. Seven of 18 studies reported favorable patient satisfaction with a scribe. No studies reported negative provider or patient satisfaction with scribes. Conclusion:Overall, we found that scribes improved RVUs per hour, RVUs per encounter, patients per hour, provider satisfaction, and patient satisfaction. However, we did not identify an improvement in ED length of stay. Future studies are needed to determine the cost-benefit effect of scribes and ED volume necessary to support their use. [

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“…11,12,14,16,22–24 Additionally, scribes decrease the time physicians spend documenting, both in and after the visit. 10,12,17,24,25…”

Section: Discussionmentioning

confidence: 99%

“…11,12,14,16,[22][23][24] Additionally, scribes decrease the time physicians spend documenting, both in and after the visit. 10,12,17,24,25 While the primary satisfaction focus of this study was the effect of scribes on patient satisfaction, the Press Ganey does also ask two questions relating to patient wait times, which can be thought of as a patient-centered measure of efficiency: was the patient seen in under 15 minutes; and how satisfied were patients with their wait time. Currently, there is no published data on the effect of scribes on wait times.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, it raises concern of responder bias. Therefore, there is need for a larger, prospective study 20 Primary care clinic Physician satisfaction Self-developed survey Increased Time to complete encounter documentation Decreased Patient satisfaction Self-developed survey High Sattler et al 21 Primary care clinic Physician satisfaction Free response questionnaire Qualitative increase Bank et al 22 Cardiology 24 Emergency department Physician satisfaction Self-developed survey No difference Physician productivity ED length of stay No difference RVUs Increased Self-reported time spent with patients No difference Self-reported time spent documenting Decreased Heaton et al 25 Emergency department Physician productivity Time spent documenting Decreased Time spent reviewing records No difference Time spent with patients and team members No difference Koshy et al 26 Urology clinic Physician satisfaction Self-developed survey No difference Patient satisfaction Self-developed survey Increased to better assess effect of scribes on patient satisfaction in an otolaryngology clinic. Ideally, future studies will use Press Ganey questions, as they are standardized, validated, and would allow for direct comparison with this study, as well as several studies from other literature ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Medical Scribes on Patient Satisfaction in an Academic Otolaryngology Clinic

Keefe

Levi

Brook

2019

Ann Otol Rhinol Laryngol

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Objectives: Evidence shows that scribes can improve provider efficiency and satisfaction in several settings, but is mixed on whether scribes improve patient satisfaction. We studied whether scribes improved patient satisfaction in an academic otolaryngology clinic. Methods: The authors performed a retrospective review of patient responses to the Press Ganey survey between 12/2016 and 12/2017. Their responses about satisfaction with the provider and wait times were examined. Three providers worked with scribes during this year; each spent six months with a scribe and six without. The authors compared survey responses from periods with and without scribes using the Fischer exact test. Average overall provider ratings were compared using the Student’s t-test. Results: A total of 87 patients filled out Press Ganey surveys for the 3 providers over the year: 54 for visits without scribes, and 33 for visits with scribes. Fischer exact analysis demonstrated no significant difference in satisfaction with providers and wait times for both individual providers and all providers combined (all P > .05). There was also no difference in patients’ likelihood of recommending the provider’s office ( P = .91). Overall provider rating (0-10 scale) was high without scribes (9.48 ± 1.06) and was unchanged by the presence of scribes (9.53 ± 0.8) ( P = .97). Conclusion: Patient satisfaction with wait times and providers was high overall and was not affected by the presence of a medical scribe.

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Time Motion Analysis: Impact of Scribes on Provider Time Management

Cited by 16 publications

References 16 publications

Interaction Time with Electronic Health Records: A Systematic Review

Interaction Time with Electronic Health Records: A Systematic Review

Effect of Medical Scribes on Throughput, Revenue, and Patient and Provider Satisfaction: A Systematic Review and Meta-analysis

The Impact of Medical Scribes on Patient Satisfaction in an Academic Otolaryngology Clinic

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