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R. Arya, M.D., D. Salovich_ , and M. Merlin, D.O. ... Scribes assist physicians with the clerical aspects of patient care with the ... – PowerPoint PPT presentation

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Title: 48x48 Poster Template

Impact of Scribes on Performance Indicators in
the Emergency Department R. Arya, M.D., D.
Salovich?, and M. Merlin, D.O. Department of
Emergency Medicine, UMDNJ- Robert Wood Johnson
Medical School, Piscataway, NJ ? Medical Student,
UMDNJ- Robert Wood Johnson Medical School
  • Study Design
  • A retrospective case-control study from July 1,
    2006 through December 31, 2007
  • Performance indicators
  • RVU per hour
  • Patients per hour
  • Turnaround Time (TAT) for discharge
  • Participants
  • Thirteen Board Certified Emergency Physicians
  • 3562 clinical hours evaluated.
  • 358 clinical shifts
  • Shifts evaluated when scribe was not present
  • Matched by day of week
  • Matched by time of shift
  • High acuity patients over 20 years
  • Setting
  • Adult Emergency Department at a University Based
  • Scribes are touted as a way to increase physician
  • Scribes assist physicians with the clerical
    aspects of patient care with the intent of
    improving physician productivity.
  • Their roles are diverse including
  • Recording patient histories and physical exams
  • Documenting procedures
  • Following up on lab reports and
  • Assisting with discharges

Outcome Variable Effect Estimate Model 1 Model 2
RVU per hour Scribes 0.18 (0.07) .0067 0.24 (0.07) .0011
PAs -- 0.20 (0.10) .0418
Scribes variation .2108 .4447
Patients per Hour Scribes 0.05 (0.02) .0399 0.08 (0.02) 0.0024
PAs -- 0.09 (0.03) 0.0056
Scribes variation .2216 .3082
  • Identification of factors that enhance physician
    productivity is important to the specialty of
    Emergency Medicine.
  • Scribes can afford the average emergency
    physician the ability to
  • Evaluate and treat more patients
  • Potentially generating increased Relative Value
    Units (RVUs)
  • Maintaining high levels of patient satisfaction
  • However, hiring and maintaining an active scribe
    program can be a potentially costly endeavor
    depending on work hours and benefits.
  • Unfortunately, not much published data
  • Many current articles use only anecdotal evidence
    to justify the need to initiate a scribe program.

Table 1 Effects of independent variables on
outcome variables from different models with
alternative combinations of independent
variables For RVU and Patients per Hour, Model 1
includes PerScribes, and Model 2 includes
  • This was a retrospective study
  • Most of the control scribe shifts were nights and
    weekends with less volume
  • Did not assess other outcome measures such as
  • Door to Doctor
  • Patient Satisfaction
  • Limited assessment of shift acuity
  • It is unknown if these results can be
    extrapolated to academic Emergency Departments
    settings where residents are present

  • Without controlling for percent Physician
    Assistant use
  • 10 increase in scribe usage results in a 0.18
    increase in RVU/Hr (p0.0067, SE 0.07)
  • 10 increase in scribe usage results in a 0.05
    increase in Patients/Hr (p0.0399, SE0.02)
  • Controlling for percent Physician Assistant use
  • 10 increase in scribe usage results in a 0.24
    increase RVU/Hr (p0.0011, SE 0.07)
  • 10 increase in scribe usage results in a 0.08
    increase in Patients/Hr (p0.0024, SE0.02)
  • No SS difference with scribes in TAT for
    discharge patients

  • To determine if scribes increase emergency
    physician productivity by evaluating primary
    endpoints of
  • Patients per hour (PPH)
  • Relative Value Units (RVUs) per hour
  • Turn around time (TAT) to discharge
  • in shifts with scribes versus shifts without
  • We considered a physician generating greater
    RVUs per hour as a potential justification of
    the expense of a scribe program.

Statistically significant changes in RVU/hr and
PPH were demonstrated with scribes Potential to
increase the number of patients seen per hour by
0.8 When moving from 0 scribes to 100 scribe
utilization Determination of scribe coverage by
increasing ED volume now possible Additional
studies are needed to determine how to maximize
scribe usage and the affect on other metrics
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