Background: Is it possible for scribes to improve ED throughput in addition to alleviating the documentation burden experienced by providers? At various institutions, scribes have been tasked with ancillary responsibilities in order to facilitate patient flow. However, the full effectiveness of these programs remains unknown. The objective of this study was to investigate the LOS impact of having scribes serve as both a flow coordinator and documentation specialist in the mid and low-acuity zones of an academic ED.
Methods: A retrospective cohort study compared patient volume and average LOS before and after implementation of a scribe-flow coordinator program. In addition to documentation, interventions included ensuring optimal staff communication, mitigating consultant delays, and proactively tracking lab and imaging results. Patients were triaged to the mid-acuity Vertical Zone (primarily ESI 3) or low-acuity Fast Track (primarily ESI 4 and 5) at a tertiary academic ED. Patients were stratified by treatment zone, acuity level, and disposition. All patients seen in the study period without missing electronic medical record data were included in the study.
Results: The pre-intervention and post-intervention periods included 8900 patients and 9935 patients, respectively. In the Fast Track, the proportion of patients aged 18-64 years decreased significantly by 3.3%. There were no other significant demographic changes. LOS for patients discharged from the Vertical Zone decreased by 12 minutes from 235 to 223 minutes (p<0.0001, 95%CI -17 to -7) despite a 10% increase in volume. For patients admitted from the Vertical Zone, volume increased 13% and LOS remained almost the same, increasing from 225 to 228 minutes (p=0.532, 95%CI -6 to 12). For patients discharged from the Fast Track, volume increased 14% and LOS increased 6 minutes, from 89 to 95 minutes (p<0.0001, 95%CI 4-9). Predictably, only 1% of Fast Track patients were admitted.
Conclusion: Despite substantially increased volume, the use of scribes as flow facilitators in the mid-acuity setting--where patients generally require a more involved medical workup--was associated with decreased LOS. In the low-acuity zone--where disposition is often immediate--scribes were not shown to be as effective, perhaps because rapid patient turnover required them to focus on documentation.