The use of scribes is becoming increasingly prevalent in today’s healthcare environment as organizations look for ways to improve the efficiency and productivity of practicing physicians. Traditionally, the role of the scribe is to assist with documentation, allowing the physician to focus his or her time on delivering billable services and ensuring that that the medical record supports the appropriate level of billing. Today - due in part to the adoption of electronic health records (EHRs) - the role of the scribe has evolved and there is increased awareness around the impact that scribes can have on patient experience.
A recent article in Becker's Hospital Review shared the findings of a cost/benefit study of scribes. Two emergency departments were studied and in both organizations, measureable improvements were realized in areas such as patients per hour, RVU per patient, and Door-to-Doctor time. The study demonstrates a positive return on investment (ROI) to the emergency departments as a result of improved physician productivity. For one organization, the use of scribes resulted in an annual savings of more than $62,000.i
While an organization may hire scribes to improve efficiency and capture revenue, it's important to remember that scribes can also play an important role in enhancing patient experience. Having a scribe in the room allows the physician to focus on key drivers of patient experience such as eye contact, body language, position (sitting vs. standing), therapeutic touch, and active listening. During the physical exam, physicians are able to describe and articulate the findings to the patient and the scribe at the same time, making the patient feel informed and involved in their care.
Research shows that scribes can indeed have a positive effect on patient experience. One study published in the American Journal of Emergency Nursing found that the introduction of scribes into the emergency department (ED) resulted in decreased patient length of stay, and emergency physician satisfaction and increased patent satisfaction.ii Another study published in Dove Medical Press Ltd showed that the use of scribes resulted not only in improved physician productivity, but also in an increase in patient satisfaction.iii
The presence of a scribe can enhance the physician's ability to function as an active listener. For instance, when summarizing a conversation for the benefit of the scribe, the physician may state "What I hear you saying is that you've been having abdominal pain the last three weeks, but that it has gotten much worse in the last 24 hours." This validates the physician is attentive to the patient's concerns while it allows the scribe to summarize the important notes.
Scribes can also magnify their impact by checking back in with patients and alerting the physician, for example, when test results are back from the lab or when a patient bed is ready. This directly impacts the patient's perception of their care from the physician and the entire care team.
Here's an example of what a patient interaction might sound like using the 'A' and 'I' in Studer Group's AIDET® communication framework:
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A
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Acknowledge
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Provider makes eye contact, smiles and acknowledges patient and family members upon entering the room.
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I
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Introduce
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"Hello, Ms. Phillips. My name is Dr. Kosowsky and I'll be the physician taking care of you today. I'd like to introduce my colleague, Lisa. Lisa is a scribe at in our emergency department, and I've had the pleasure of working with her for the last 3 years. Her role is to document our encounter and to make sure your medical record is complete, accurate and reflects everything we discussed. This allows me to spend more time face-to-face with you, focusing on your concerns and how we can try to address them."
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Finally, I recommend that physicians dedicate some time to educating scribes and integrating them into the clinical team. While most scribes start out with limited medical background, many go on to become nurses, PA's and physicians. As physicians, we should take the opportunity to inspire them and make them feel like valuable members of the care team.
Whether you are currently using or considering the use of scribes, we hope this Insight provides helpful information for the business case, and more importantly, the impact scribes can have on patients and the entire organization. Below are some references to help you further determine whether scribes are right for your organization.
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iHarris, R, MD; Switaj, M, MBA. Are Medical Scribes Worth the Investment? Becker's Hospital Review. June 13, 2013.
iiBastani, A MD; Shaqiri, B MS; Palomba, K BS; Bananno, D BA; Anderson, W MD. An ED scribe program is able to improve throughput time and patient satisfaction. American Journal of Emergency Medicine, 32 (2014) 399-402. doi:10.1016/j.ajem.2013.03.040
iiiBank et al. Impact of scribes on patient interaction, productivity, and revenue in a cardiology clinic: a prospective study. Clinicoecon Outcomes Res. 2013; 5: 399–406. Published online 2013 Aug 9. doi: http://dx.doi.org/10.2147/CEOR.S49010