title: Scribe Impacts on Provider Experience, Operations, and Teaching in an Academic Emergency Medicine Practice.
abstract: BACKGROUND
  Physicians dedicate substantial time to documentation. Scribes are sometimes used to improve efficiency by performing documentation tasks, although their impacts have not been prospectively evaluated. Our objective was to assess a scribe program's impact on emergency department (ED) throughput, physician time utilization, and job satisfaction in a large academic emergency medicine practice.
  
  
  METHODS
  We evaluated the intervention using pre- and post-intervention surveys and administrative data. All site physicians were included. Pre- and post-intervention data were collected in four-month periods one year apart. Primary outcomes included changes in monthly average ED length of stay (LOS), provider-specific average relative value units (RVUs) per hour (raw and normalized to volume), self-reported estimates of time spent teaching, self-reported estimates of time spent documenting, and job satisfaction. We analyzed data using descriptive statistics and appropriate tests for paired pre-post differences in continuous, categorical, and ranked variables.
  
  
  RESULTS
  Pre- and post-survey response rates were 76.1% and 69.0%, respectively. Most responded positively to the intervention, although 9.5% reported negative impressions. There was a 36% reduction (25%-50%; p<0.01) in time spent documenting and a 30% increase (11%-46%, p<0.01) in time spent in direct patient contact. No statistically significant changes were seen in job satisfaction or perception of time spent teaching. ED volume increased by 88 patients per day (32-146, p=0.04) pre- to post- and LOS was unchanged; rates of patients leaving against medical advice dropped, and rates of patients leaving without being seen increased. RVUs per hour increased 5.5% and per patient 5.3%; both were statistically significant. No statistically significant changes were seen in patients seen per hour. There was moderate correlation between changes in ED volume and changes in productivity metrics.
  
  
  CONCLUSIONS
  Scribes were well received in our practice. Documentation time was substantially reduced and redirected primarily to patient care. Despite an ED volume increase, LOS was maintained, with fewer patients leaving against medical advice but more leaving without being seen. RVUs per hour and per patient both increased.
authors.affiliation: Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Hess
authors.affiliation: Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Wallenstein
authors.affiliation: Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Ackerman
authors.affiliation: Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Murtaza
authors.initials: M
authors.lastname: Akhter
authors.affiliation: Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Douglas
authors.initials: D
authors.lastname: Ander
authors.affiliation: Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Keadey
authors.affiliation: Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
authors.forename: James P
authors.initials: JP
authors.lastname: Capes
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D004282:Documentation / Q000379:methods / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007588:Job Satisfaction; D007902:Length of Stay / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013663:Teaching / Q000706:statistics & numerical data*