48x48 Poster Template

1
Impact of Scribes on Performance Indicators in
the Emergency Department R. Arya, M.D., D.
Salovich?, and M. Merlin, D.O. Department of
Emergency Medicine, UMDNJ- Robert Wood Johnson
Medical School, Piscataway, NJ ? Medical Student,
UMDNJ- Robert Wood Johnson Medical School
Introduction
Methods
Data

• Study Design
• A retrospective case-control study from July 1,
  2006 through December 31, 2007
• Performance indicators
• RVU per hour
• Patients per hour
• Turnaround Time (TAT) for discharge
• Participants
• Thirteen Board Certified Emergency Physicians
• 3562 clinical hours evaluated.
• 358 clinical shifts
• Shifts evaluated when scribe was not present
• Matched by day of week
• Matched by time of shift
• High acuity patients over 20 years
• Setting
• Adult Emergency Department at a University Based
  Academic

• Scribes are touted as a way to increase physician
  productivity.
• Scribes assist physicians with the clerical
  aspects of patient care with the intent of
  improving physician productivity.
• Their roles are diverse including
• Recording patient histories and physical exams
• Documenting procedures
• Following up on lab reports and
• Assisting with discharges

Outcome Variable Effect Estimate Model 1 Model 2
RVU per hour Scribes 0.18 (0.07) .0067 0.24 (0.07) .0011
PAs -- 0.20 (0.10) .0418
Scribes variation .2108 .4447
Patients per Hour Scribes 0.05 (0.02) .0399 0.08 (0.02) 0.0024
PAs -- 0.09 (0.03) 0.0056
Scribes variation .2216 .3082
Purpose

• Identification of factors that enhance physician
  productivity is important to the specialty of
  Emergency Medicine.
• Scribes can afford the average emergency
  physician the ability to
• Evaluate and treat more patients
• Potentially generating increased Relative Value
  Units (RVUs)
• Maintaining high levels of patient satisfaction
  
• However, hiring and maintaining an active scribe
  program can be a potentially costly endeavor
  depending on work hours and benefits.
• Unfortunately, not much published data
• Many current articles use only anecdotal evidence
  to justify the need to initiate a scribe program.

Table 1 Effects of independent variables on
outcome variables from different models with
alternative combinations of independent
variables For RVU and Patients per Hour, Model 1
includes PerScribes, and Model 2 includes
PerScribesPthr.
Limitations

• This was a retrospective study
• Most of the control scribe shifts were nights and
  weekends with less volume
• Did not assess other outcome measures such as
• Door to Doctor
• Patient Satisfaction
• Limited assessment of shift acuity
• It is unknown if these results can be
  extrapolated to academic Emergency Departments
  settings where residents are present

Results

• Without controlling for percent Physician
  Assistant use
• 10 increase in scribe usage results in a 0.18
  increase in RVU/Hr (p0.0067, SE 0.07)
• 10 increase in scribe usage results in a 0.05
  increase in Patients/Hr (p0.0399, SE0.02)
• Controlling for percent Physician Assistant use
• 10 increase in scribe usage results in a 0.24
  increase RVU/Hr (p0.0011, SE 0.07)
• 10 increase in scribe usage results in a 0.08
  increase in Patients/Hr (p0.0024, SE0.02)
• No SS difference with scribes in TAT for
  discharge patients

Objective
Conclusion

• To determine if scribes increase emergency
  physician productivity by evaluating primary
  endpoints of
• Patients per hour (PPH)
• Relative Value Units (RVUs) per hour
• Turn around time (TAT) to discharge
• in shifts with scribes versus shifts without
  scribes.
• We considered a physician generating greater
  RVUs per hour as a potential justification of
  the expense of a scribe program.

Statistically significant changes in RVU/hr and
PPH were demonstrated with scribes Potential to
increase the number of patients seen per hour by
0.8 When moving from 0 scribes to 100 scribe
utilization Determination of scribe coverage by
increasing ED volume now possible Additional
studies are needed to determine how to maximize
scribe usage and the affect on other metrics