The Scribe Effect – When Help Turns into Hindrance
August 30, 2024
Written by Shannon Markus
Spoon Feed
The MISSION Act Scribes Trial evaluated the implementation of medical scribes in Veterans Health Administration (VHA) EDs. Contrary to expectations, scribes decreased provider productivity and increased patient throughput times.
Help or hindrance?
The 2018 MISSION Act supported a two-year trial to assess the use of medical scribes in the VHA to enhance access to care, decrease provider burnout, and improve overall patient and provider satisfaction. The largest randomized scribe trial to date, it used a clustered randomized design. Twelve VHA EDs were studied (six intervention, six control) for 2 years. Surprisingly, scribes decreased provider productivity and increased patient throughput times, contrasting with previous research. The study found:
- 0.5 fewer patients/day/provider.
- Length of stay increased by 29.1 minutes.
- Door-to-doctor times increased by 6.3 minutes.
- Door-to-disposition times increased by 19.5 minutes.
- Doctor-to-disposition times increased by 13.7 minutes.
The study had several very important limitations; scribe hiring, retention, and turnover challenges impacted training and adaptation to clinical operations. Conducted during the COVID-19 pandemic, the trial was affected by a surge of severely ill patients and revised safety protocols, which were highly disruptive to ED operations in and of themselves. This led to inefficient and infrequent scribe use due to safety concerns.
Will this change my practice?
It won’t in the short term. I’ve had both good and bad experiences with scribes. Untrained scribes slow me down and complicate documentation with errors. However, well-trained scribes who master terminology, efficiency, and workflow are invaluable – it feels like hitting the jackpot! This underscores the importance of quality training and consistency to effectively integrate scribes into ED workflows.
Source
Effect of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act Scribes Trial on Emergency Department Provider Productivity and Patient Throughput Times. J Emerg Med. 2024 Jul;67(1):e89-e98. doi: 10.1016/j.jemermed.2024.03.036. Epub 2024 Mar 30.