The Case for Medical Scribes in Emergency Care

In a recent study, Minneapolis-based Allina Health compared physician productivity, hospital revenue, patient satisfaction and the quality of physician-patient interaction before and after the introduction of scribes into an Allina Health emergency department.

Before the addition of scribes, the four physicians in the study saw 129 patients in 65 clinic-hours, spending 40 minutes with new patients and 20 minutes for follow-ups. After scribes were introduced, the physicians saw 210 patients in the same number of clinic-hours, spending 30 minutes with new patients and 15 minutes for follow-ups, with no decrease in Allina Health's high patient satisfaction ratings.

Scribes also helped boost Allina Health's ED revenue — the use of scribes was found to be associated with an increase of both direct and indirect revenue gains of between $142 and $2,398 per patient, with a total of $205,740 additional revenue brought in from the additional 81 patients seen by the four physicians using the scribes.

Allina Health is not the only provider to turn to medical scribes. An estimated 10,000 medical scribes are currently employed by healthcare providers nationwide, according to an article in The Wall Street Journal. The scribes, often medical students, usually join a physician during a consult and enter needed information into the patient's electronic medical record with the goal of increasing efficiency while allowing the physician to focus more fully on the patient.

Medical scribes are becoming more in-demand as hospitals and health systems see the $8 to $16 per hour it costs to hire each medical scribe as worth the added physician productivity and the increased job satisfaction of physicians who no longer have to stay late to type information into a medical record.

"The number one benefit is that it gets the physician away from data entry," says Fermin Barrueto, MD, the ED director at University of Maryland Upper Chesapeake Health in Bel Air. "It allows them to spend time with the patients and [spend time] reviewing laboratory results and X-rays. It does improve care overall."

UM UCH went live on its EMR in 2012, and six months after go-live began piloting the use of scribes in the ED. "We saw an improvement right away in door-to-bed times," says Dr. Barrueto. The system eventually saw such improvements in efficiency and patient satisfaction that the use of scribes was expanded to all physicians in the system's two EDs, he says.

At Brigham and Women's Hospital in Boston, the introduction of scribes into the urgent care setting has had a significant impact on provider satisfaction. "They liberate providers to have a more personal interaction with their patients," says Christopher Baugh, MD, an emergency medicine physician who helped bring scribes to BWH's clinic in Foxborough, Mass. "I love shaking hands and sitting down next to the patient… [with scribes] I can focus on the patient and not be distracted by a computer."

Additionally, the introduction of scribes has had a positive effect on physicians' work-life balance. "We work long days and having to write 40 or more notes at the end of the day, that's tough to sustain," says Dr. Baugh. "The idea of being done [when patient visits are completed], editing a near-final note and finishing up on time is really attractive."

However, scribes are only as good as their training, says Dr. Barrueto. Any efficiency gains are lost if a physician has to re-do notes entered by a medical scribe who misses either crucial information or the nuances of the encounter. "If the notes aren't as specific or accurate as a physician likes, the physician still has to change them," he says. "That's why scribe training is so important."

Expenses related to training scribes add to their overall cost, meaning some providers may be unable to afford them on persistently thin operating margins. Additionally, when providers with scribes experience a drop in reimbursements, "scribes will probably be first on the chopping block," says Dr. Barrueto.

It's also why, though scribes may be useful in other departments, their use will likely remain in the ED or urgent care settings, where high patient volumes make efficiency gains more noticeable. It's in emergency medicine where scribes offer the biggest boost to physician satisfaction as well, says Dr. Barrueto. "ED scribes fill an important niche with doctors' heavy loads and the rapid turnarounds," he says. "In most groups, having scribes is a competitive edge in terms of recruiting physicians and maintaining their work-life balance."

As scribes are an answer to cumbersome EMR systems and intrusive computer monitors, their necessity might fade as technology improves. Tablets and a growing number of EMR apps allow physicians to access a patient's medical record during a consult without wheeling in a computer workstation, and many physicians are taking advantage of speech recognition software. Additionally, technology like Google Glass is poised to provide physicians easier access to patients' records — a Glass pilot at Beth Israel Deaconess Medical Center in Boston allows ED physicians hands-free access to patient information, and a new Glass app from health IT startup Augmedix is able to record information gathered during a patient consult directly to an EMR system. Both advancements would reduce the need for medical scribes.

However, many of these advancements are years off, at least for most hospitals and health systems. "As technology improves, the need for scribes may diminish," says Dr. Baugh. "But I still see value in scribes for the foreseeable future."

More Articles on Medical Scribes:

Medical Scribes Increase Efficiency, Revenue for Allina Health
4,000 Clicks Per Shift: ED Physicians' EMR Burden
3 Strategies to Optimize the Value of Hospital EDs

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