title: Impact of scribes on emergency department patient throughput one year after implementation.
abstract: OBJECTIVE
  Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation.
  
  
  METHODS
  A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity.
  
  
  RESULTS
  Adult: Overall length of stay (LOS) was essentially the same in both groups (214 vs. 215min, p=0.34). In area A where staffing includes an attending and residents, scribes made a significant impact in treatment room time in the afternoon (190 vs 179min, p=0.021) with an increase in patients seen per hour on scribed days (2.00 vs. 2.13). There was no statistically significant changes in throughput metrics in area B staffed by an attending and a nurse practitioner/physician assistant, however scribed days did average more patients per hour (2.01 vs. 2.14). Pediatric: All throughput measurements were significantly longer when the treatment team had a scribe; however, patients per hour increased from 2.33 to 2.49 on scribed days.
  
  
  CONCLUSIONS
  Overall patient throughput was not enhanced by scribes. Certain areas and staffing combinations yielded improvements in treatment room and door to provider time, however, scribes appear to have enabled attending physicians to see more patients per hour. This effect varied across treatment areas and times of day.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States. 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, United States.
authors.forename: David M
authors.initials: DM
authors.lastname: Nestler
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
authors.forename: Annie T
authors.initials: AT
authors.lastname: Sadosty
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D002675:Child, Preschool; D004282:Documentation / Q000379:methods / Q000592:standards; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008497:Medical Record Administrators / Q000193:education / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D000070316:Pediatric Emergency Medicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D011446:Prospective Studies