Scribes are the heroes of Emergency Physicians but what is the evidence behind their impact?

Author: Heather Heaton, MD

Editor's Note. The Following post is authored by Heather Heaton, an attending at Mayo Clinic Department of Emergency Medicine. For most of her academic career Heather has focused in the implementation and research of scribes in emergency departments (ED) and is probably one of the world's foremost experts in the topic. This summary is based on two of her papers, one of them is a systematic review about the impact of scribes in ED operations and the other is an observational study on ED metrics, both of them are a must-read for healthcare providers specializing in operations and particularly scribes.

Impact of an scribe program in ED metrics (AJEM, 2016)

Systematic review on the impact of scribes on ED metrics and provider satisfaction (AJEM, 2016)

Fifteen years ago I began my career in medicine by working for one of the first Emergency Medicine scribe companies.  While the scribe program was large, the industry hadn’t become the behemoth that it is today. My role as an integral member a healthcare team in the Emergency Department was to decrease clerical burden by assisting with documentation and improving efficiency and workflow by acting as what my employer termed an “air traffic controller” for the physician.  Much like an air traffic controller ensures the safety of passengers, ensures efficient flow of airplanes at the airport and helps to locate missing aircraft I served a similar purpose in the ED.  I ensured the safety of patients by accurately handwriting the history and physical as well as the clinical notes.  I transcribed the lab results and imaging reads onto the medical record.  I documented re-checks and consult notes while also tracking missing lab results to improve patient care and workflow.

Though scribes were initially used in the Emergency department, scribe use throughout the healthcare system is becoming increasing common.  Several articles published over the last five years anecdotally support the use of scribes in pediatric wards, inpatient services, Emergency Departments and family medicine clinics.  Scribe companies provide information on the benefit of scribes on physician and patient satisfaction. However, there is a paucity of peer-reviewed literature supporting the emerging role of scribes and any potential economic benefit in healthcare despite the rapid expansion of scribe services.  In order to address this question our group completed a systematic review and meta-analysis of peer reviewed literature to date to help understand the true economic and departmental impact of scribes.  Of the 210 titles we reviewed, 17 studies were eligible and included in our publication.  Overall, scribes appeared to have no impact on patient specific throughput metrics (length of stay, etc) though providers saw a significant increase in patients seen per hour.  RVUs appear to increase when scribes were a part of the care team and there is limited but positive data that scribes improve the provider experience.  However, given the lack of standardization involved in the metrics and analyses of the studies the data remain difficult to interpret.

Our manuscript begins a discussion on scribes in healthcare and highlights the need for ongoing carefully controlled and standardized studies in this rapidly growing field.  Beyond an impact on clinical operations, scribes may provide some much needed relief for providers that continuously struggle with ever increasing clerical burden and physician burnout.

References

• Heaton HA, Castaneda-Guarderas A, Trotter ER, Erwin PJ, Bellolio MF. Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis. Am J Emerg Med. 2016 Oct;34(10):2018-2028. doi: 10.1016/j.ajem.2016.07.056. Review. PubMed PMID: 27534432.
• Heaton HA, Nestler DM, Jones DD, Lohse CM, Goyal DG, Kallis JS, Sadosty AT. Impact of scribes on patient throughput in adult and pediatric academic EDs. Am J Emerg Med. 2016 Oct;34(10):1982-1985. doi: 10.1016/j.ajem.2016.07.011. PubMed PMID: 27450391.

Image by  NATS Press Office via flickr under CC BY-NC-ND 2.0

License here