Scribes in the Emergency Department
Posted September 2016
Imagine going to work every day and being able to do the part of your job that you really enjoy and leaving off all of the burdensome things that you do because you just have to. Imagine being able to use your education, training and experience while someone else does the “busy work.” Now imagine that this actually help you and your company do a better job and accomplish more. It sounds a little too good to be true doesn’t it.
When you think of the word “scribe”, your mind might go to monastery centuries ago where scribes meticulously copied texts and dreamed of the day the printing press would be invented. In the modern world of healthcare, the term means something entirely different. Today, scribes are used as documentation assistants for physicians.
The most prominent setting for medical scribes is the Emergency Department. The unpredictable and often fast-paced nature of emergency medicine can make documentation feel like a secondary task. Unfortunately, the medico-legal and reimbursement environment make documentation a priority. Electronic health records have generally added to the documentation burden rather than alleviating it. Emergency department physicians are facing increasing volumes, long hours of work and high rates of “burnout” as a result of these and other factors. In some cases, the medical scribe can be a soothing balm for some of these ills.
Scribes are individuals trained in medical terminology and electronic health record systems who assist physicians in the chore of entering data in the patient record. They typically shadow the physician as the patient is interviewed and examined. In ideal situations, the information obtained by the physician is being contemporaneously entered by the scribe. This process is fast, efficient and likely improves accuracy and completeness in the record.
There are a number of upsides for the use of scribes in the ED. Freeing the physician from the data entry tasks allows for more time to be spent with the patient. This makes the physician and the patient happier. It allows the physician to have fewer distractions from actually thinking about the case. Diagnoses and treatments may be improved. It has been shown in several studies to improve the physician’s efficiency as measured by patients per hour. This, in turn, leads to fewer patients leaving without being seen. Ultimately, the increase in productivity and improved documentation can lead to increased revenue for the hospital.
The role of the medical scribe has been expanding over the years. There has actually been more of an evolution of the role to meet the various needs of the busy physician. Many scribes are now more like a professional assistant. They can help track down the results of diagnostic studies, add a layer of communication with the other hospital staff and help the physician keep track details that might otherwise get delayed or lost in the shuffle.
There are some potential downsides. The training for scribes is not standardized and there is no real benchmarking. In reality, scribes typically receive more training on the electronic health record system than most physicians do. Some physicians worry that patients may not be as forthcoming with information if there is someone else present in the room. In spite of that fear, there is a strong suggestion that patient satisfaction goes up with the use of scribes, somewhat mitigating that concern. There are also concerns about privacy and infection control. However, good scribe programs will ensure that scribes go through the same human resources protocols as other hospital employees to address these concerns.
There is also the financial issue. Scribes don’t typically work for free. Even when considering the cost, there is still a strong financial case to be made. Scribes are not ideal in all settings and the costs may not be justified in every situation. In some settings, the use of scribes may only be justified during peak hours or on certain busier days of the week.
It may not be the panacea for the emergency department physician, but the use of scribes certainly has its place. Done well, in the right environment, scribes can be an important member of the team.