Impact of scribes on patient throughput in adult and pediatric academic EDs

Heather A Heaton, David M Nestler, Derick D Jones, Christine M Lohse, Deepi G Goyal, Jeffrey S Kallis, Annie T Sadosty
American Journal of Emergency Medicine 2016, 34 (10): 1982-1985

OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) patient-specific throughput.

METHODS: Study design, setting, participants: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED.

INTERVENTION: Eight scribes were hired and trained on-site by a physician with experience in scribe implementation. Scribes provided 1-to-1 support for a provider's work shift. An alternating-day pattern in months 2 to 5 post implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity.

RESULTS: Adult: Overall length of stay (LOS) was significantly longer for scribed patients (265 vs. 255 minutes, P=.028). The remaining throughput measures analyzed (door to provider, provider to disposition, and patient duration in treatment room) had higher summary values, but were not significant. Subgroup analysis revealed that patients seen by postgraduate year (PGY) 3 residents had significantly shorter LOS when seen with a scribe (244 vs. 262 minutes, P=.021). Pediatric: Overall LOS (163 vs. 151 minutes, P=.011), door to provider (21 vs. 16 minutes, P<.001), and treatment room duration (130 vs. 123 minutes, P=.020) were significantly longer when the treatment team had a scribe.

CONCLUSIONS: Scribes failed to improve patient-specific throughput metrics in the first few months post implementation. Future work is needed to understand whether throughput efficiencies may eventually be gained after scribe implementation.

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