title: Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis.
abstract: BACKGROUND
  Scribes offer a potential solution to the clerical burden and time constraints felt by health care providers.
  
  
  OBJECTIVE
  This is a systematic review and meta-analysis to evaluate scribe effect on patient throughput, revenue, and patient and provider satisfaction.
  
  
  METHODS
  Six electronic databases were systematically searched from inception until May 2015. We included studies where clinicians used a scribe. We collected throughput metrics, billing data, and patient/provider satisfaction data. Meta-analyses were conducted using a random effects model and mean differences (MDs) with 95% confidence intervals (CIs) with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.
  
  
  RESULTS
  From a total of 210 titles, 17 studies were eligible and included. Qualitative analysis suggests improvement in provider/patient satisfaction. Meta-analysis on throughput data was derived from 3 to 5 studies depending on the metric; meta-analysis revealed no impact of scribes on length of stay (346 minutes for scribes, 344 minutes for nonscribed; MD -1.6 minutes, 95% CI -22.3 to 19.2 minutes) or provider-to-disposition time (235 minutes for scribes, 216 for nonscribed; MD -18.8 minutes, 95% CI -22.3 to 19.2) with an increase in patients seen per hour (0.17 more patient per hour; 95% CI 0.02-32). Two studies reported relative value units, which increased 0.21 (95% CI 0-0.42) per patient with scribe use.
  
  
  CONCLUSIONS
  We found no difference in length of stay or time to disposition with a small increase in the number of patients per hour seen when using scribes. Potential benefits include revenue and patient/provider satisfaction.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Electronic address: Heaton.heather@mayo.edu.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Heaton
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905; Knowledge and Evaluation Research Unit, Plummer 4, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
authors.forename: Ana
authors.initials: A
authors.lastname: Castaneda-Guarderas
authors.affiliation: Department of Emergency Medicine, Texas Health Harris Methodist Hospital, 1301 Pennsylvania Ave, Fort Worth, TX 76104.
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Trotter
authors.affiliation: Mayo Clinic Libraries, 200 First St SW, Rochester, MN 55905.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
authors.forename: M Fernanda
authors.initials: MF
authors.lastname: Bellolio
mesh_terms: D001291:Attitude of Health Personnel; D004282:Documentation / Q000379:methods*; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007182:Income; D007902:Length of Stay; D017060:Patient Satisfaction; D000078329:Workforce