ER Medical Scribe - The Key to Maximizing ED Efficiency

Medical scribes were initially seen working in fast paced environments in the emergency rooms, accompanying physicians during patient visits. With EDs being generally busy it turns out that medical scribes were assisting emergency physicians with charting and as well as a range of other tasks. And thanks to technology, it has changed the aspect entirely and today medical scribes are increasingly working online, even from the other corner of the world. ER scribes provide real-time charting and form an integral part of patient care focusing on efficiency and satisfaction of both the patients and providers.

Who introduced scribes in the ED?

Dr. Louis Saldana, Dallas, Texas an emergency room physician is supposed to have used medical scribes in the ED way before the EHRs were introduced. Even in the paper world, scribes were found to be an effective strategy to increase efficiency by 25% all while enhancing both provider and patient experience. And today in this digital world medical scribes are a growing trend and a valuable addition to the ED team, allowing emergency physicians to provide prompt and responsive care.

Need for scribes in an ED

Overcrowding in ED is a common problem that could lead to undesirable consequences. The increasing patient numbers in the ED made it challenging for emergency physicians to provide high quality and timely care to patients. One contributing factor to the extended length of stay in an ED is the overwhelming administrative workload. On average an emergency physician spends not less than 90 to 120 minutes in 8 hours on documentation. We know that documentation decreases physician productivity and one proposed solution is the use of scribes to assist with documentation. The utilization of scribes will not only help to ease the documentation burden but also improve ED patient flow and physician morale.

The click overload in an ED

One of the daily activities that add to the frustration of an emergency physician is ordering the painkiller Ibuprofen. This is a simple task but may require multiple mouse clicks. When prescribing for female patients an alert pops up warning that it's not safe for pregnant women and the ED physician has to override the warning with a few more clicks. Similarly, on average an emergency room physician took 6 clicks to place an order for an aspirin, 8 clicks to order a chest x-ray, 11 clicks to view an old test result, 15 clicks to provide a prescription, and 47 clicks to document a physical exam for a lower back pain. In short, on average an ER physician makes more than 4000 clicks per shift. Huff! It sounds intimidating. That is why emergency physicians turn to scribes to free them from this endless clicking task and focus their attention on patients who need emergency care.

ED physicians and burnout

The fast paced and emotionally challenging environment that prevails in an ED makes emergency physicians suffer from burnout the most. Emergency physicians work inconsistent hours and longer shifts, performing at their peak. Documentation tasks also add up to their stress levels. This culture of medicine paves the way for burnout. One promising strategy to avoid this element of burnout is to utilize medical scribes who can take over the documentation tasks. This allows ED physicians to focus on patient's acute needs instead of inputting patient data. Study says that use of medical scribes reduces burnout as they reduce the documentation burden, substantially.

Effect of scribes in an ED

1. A study was conducted to evaluate the cost-effectiveness of scribes in an ED. For this purpose a time-driven activity-based costing approach was used to assess the documentation cost for both scribe and nonscribe shifts. It was observed that physicians spent 2 hours during shift and 1 hour post shift on documentation. However, when paired with a scribe, emergency physicians spent 1 hour and 45 minutes during the shift and 15 minutes after the shift on documentation. This demonstrates that use of scribes appears to be a cost-effective solution for ED documentation. ( Heather A. Heaton, MD, David M. Nestler, MD, MS, William J. Barry, ME, MBA, Richard A. Helmers, MD, Mustafa Y. Sir, PhD, Deepi G. Goyal, MD, Derek A. Haas, MBA Robert S. Kaplan, PhD, and Annie T. Sadosty, MD)


2. Another retrospective study found that use of scribes in an ED improved physician productivity as measured by patients treated per hour and RVU generated per hour. (Rajiv Arya MD, Danielle M. Salovich, Pamela Ohman-Strickland PhD, Mark A. Merlin DO)


3. Yet another study conducted in an Australian ED observed that the use of scribes assisted ED physicians to work with increased productivity. The study found a 13% increase in consultations per hour. (Katherine J Walker, Michael Ben Meir, David Phillips, & Margaret Staples)

All of the above studies demonstrate one thing in common - Scribes improve emergency physician productivity and the number of patients seen, which is important in any healthcare setting more so in an emergency department.

The Upshot

Emergency departments are fast paced environments where physicians multitask to the core - treating patients who need immediate care and documenting at the same time. ER medical scribes aid emergency physicians with documentation so that they can focus on providing acute and life-saving care. Scribes also help emergency physicians manage the surge in patient volume. The increased efficiency that results from usage of scribes significantly reduces wait times and LWOTs. Are you an ER physician looking to reduce your documentation burden while improving patient throughput, productivity, and patient satisfaction? If yes, Scribe4Me's specialty-specific scribing service is for you. Scribe4Me provides expert ER scribes who can provide accurate documentation of patient encounters while you take quick treatment decisions and manage emergency situations.