Scribe Lovin’ in the PED

September 5, 2018

Written by Clay Smith

Spoon Feed
Scribes increased physician productivity in this single center low-acuity pediatric ED before and after study.

Why does this matter?
In the past, research on the benefit of scribes was mixed and appeared to not increase RVUs for lower acuity or pediatric patients.  This study provides evidence that they may, in fact, be helpful for peds.

Were every stalk on earth a quill and every man a scribe by trade…
This was a before and after study of about 24,000 pre-scribe and 27,000 post-scribe encounters involving lower acuity pediatric ED patients, including 18 PEM docs, 2 pediatricians, and 2 NPs.  They found that after scribes were added, productivity went up a little: 0.24 patients per hour and 0.72 RVUs per hour on average.  This was even more pronounced during the busy winter months.  After implementation, 88% of providers preferred working with a scribe.  Total ED volume went up 4.1% from pre to post-scribe implementation, which was thought to play a negligible role in increasing the number of patients per hour seen.  The urgent care part of the ED was without scribes and did not experience the same productivity increase despite increased total patient volume.  At 0.72 RVU/hr x 8h, this is an extra 5.8 RVUs/8h shift x $50 per RVU = $290 more per shift.  This should more than pay for the scribe program and may reduce burnout, physician turnover, and improve overall job satisfaction.  Looks like a win.

Source
Impact of Medical Scribes on Provider Efficiency in the Pediatric Emergency Department.  Acad Emerg Med. 2018 Aug 1. doi: 10.1111/acem.13544. [Epub ahead of print]
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Another Spoonful
EP Monthly had an article on scribes a couple years ago that goes in depth.

Reviewed by Thomas Davis