Background: Emergency department (ED) scribe research thus far has sought to quantify scribe impact on daily operations. No group has evaluated scribe impact during an electronic medical record (EMR) transition in an ED.
Methods: A prospective cohort design compared patients managed with and without scribes during pre-defined study hours in a tertiary academic ED. An alternating-day pattern ensured balance between the scribe and non-scribe groups. Throughput metrics (medians, minutes) and relative value units (RVUs, means) were collected. Data was evaluated in its entirety (three months), as well as in two subsets: go live (immediate two weeks) and adoption (two weeks post implementation to end).
Results: All patients: There was no statistically significant difference in throughput or RVUs between scribed and non-scribed patients during the three month period. However, total RVUs per scribed patient were improved during go-live (4.63 vs. 4.40, p=0.048). During adoption, scribed patients had a decreased length of stay (LOS) (221 vs 231, p=0.023). Adults: No statistically significant differences in throughput or RVUs between the groups were found. Door to provider (28 vs 37, p=0.014) and total RVUs (5.20 vs 4.92, p=0.042) were improved with scribes during go-live. Scribes impacted go-live morning shifts (provider to disposition 160 vs 203, p=0.007, treatment room 251 vs 290, p=0.022, and LOS 258 vs 301, p=0.012) and overnight shifts (door to provider 22 vs 34, p=0.019, professional RVUs 4.51 vs 4.27, p=0.033, total RVUs 4.98 vs 4.48, p=0.009), while lengthening provider to disposition during afternoon shifts (189 vs 140, p=0.016). No statistically significant differences were seen during adoption, except for longer overnight scribed provider to disposition time (154 vs 146, p=0.030). Pediatrics: In the pediatric population scribed patients had decreased professional RVUs (2.78 vs 2.90, p=0.037). When evaluating specific time frames (go-live and adoption), no statistically significant differences were seen in throughput or RVUs.
Conclusions: A scribe’s ability to mitigate operational inefficiencies introduced by an EMR transition seems limited in an academic hospital. Previous research highlighting the positive impact of scribes on revenue was not replicated.