Written by Nickolas Srica
In-person ED scribes may improve financial productivity (RVUs) and clinical efficiency, though effects are probably small and good data are lacking. Insufficient data exist to determine impact on patient or clinician satisfaction, scribe documentation quality, or differences in scribe training.
Why does this matter?
The number of EDs beginning to utilize scribes continues to grow. Prior studies have shown some preliminary data to suggest that scribes may benefit physician productivity and profit, and perhaps more importantly, they may make clinicians happier at work, but how much good evidence is really out there to support their use and widespread implementation?
Maybe a small benefit…
This was a systematic review in which electronic databases were searched from 2010 through December 2019, and 20 total studies were ultimately selected and reviewed. Each also had its risk of bias (ROB) and Certainty of Evidence (COE) rated by two independent reviewers. This ultimately included 18 observational studies and 2 randomized controlled trials, 12 of which came from just two institutions, one in Rochester, Minnesota, and one in Australia. 15 of the studies were rated as having serious or critical risk of bias, and 5 had moderate risk of bias. The review ultimately showed that scribes may increase number of patients seen per hour and RVUs (low COE), and probably decrease length of stay (low COE), but these effects were small. The overall effects of scribes on things like clinical efficiency, healthcare access, patient or clinician satisfaction, or financial productivity in EDs lacked any sufficient high-quality evidence, and there was little to no evidence on things like cost to develop and implement a scribe program, or on documentation quality and differences in scribe training. This review concluded that more information is needed on the effectiveness, harms, and costs of scribes before recommending their widespread implementation.
Effect of Medical Scribes in Emergency Departments: A Systematic Review. The Journal of Emergency Medicine. 2021 May 15. doi: 10.1016/j.jemermed.2021.02.024