Written by Nickolas Srica
Spoon Feed
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.
Source
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
Picture this:
The patient is bleeding to death from a steady LGI bleed. Blood is pooling between his legs at a frightening rate. He’s got "la belle indefferance," but I’m pretty freaked.
Big access, (a sheath), is placed immediately. Then I try to order adequate blood.
This is a per diem job at a busy community ED. Used to Trauma Center type protocols I attempt to order large quantities of PRBC, Platelets, FFP. The EMR won’t let me. (4 hours of virtual training and I was pronounced "good to go.") Repeated attempts are met with computer stop signs and a maddening computer chime.
Almost screaming now I’m asking colleagues for help, whiskey tango foxtrot, this guy need blood. "Oh, only trauma can order massive transfusion or more than one unit at a time." (This was a multi-hospital systemwide protocol hardwired in to the EMR)
Of course I ask to call the Trauma service, figuring that any surgeon would be happy to order some blood products when a scope or IR might solve the problem. "We don’t have Trauma here, we transfer them."
Basically I grabbed several colleagues who stopped what they were doing to become my scribes, advisers and navigators through the EMR and the system.
One experienced scribe probably could have done the same.