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Gottlieb M, Palter J, Westrick J, et al. Effect of Medical Scribes on Throughput, Revenue, and Patient and Provider Satisfaction: A Systematic Review and Meta-analysis. Ann Emerg Med. 2020 Aug 28. pii: S0196-0644(20)30597-7. doi: 10.1016/j.annemergmed.2020.07.031. (Systematic review)
Abstract

STUDY OBJECTIVE: Documentation in the medical record increases clerical burden to clinicians and reduces time available to spend with patients, thereby leading to less efficient care and increased clinician stress. Scribes have been proposed as one approach to reduce this burden on clinicians and improve efficiency. The primary objective of this study is to assess the effect of scribes on throughput, revenue, provider satisfaction, and patient satisfaction in both the emergency department (ED) and non-ED setting.

METHODS: PubMed, Scopus, the Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature database, Google Scholar, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched for studies assessing the effect of scribes versus no scribes on the following outcomes: patients per hour, relative value units (RVUs) per hour, RVUs per encounter, clinic length of stay, time to disposition, ED length of stay, ED length of stay for admitted patients, ED length of stay for discharged patients, provider satisfaction, and patient satisfaction. Data were dual extracted into a predefined work sheet, and quality analysis was performed with the Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Subgroup analyses were planned between ED versus non-ED studies.

RESULTS: We identified 39 studies comprising greater than 562,682 patient encounters. Scribes increased patients treated per hour by 0.30 (95% confidence interval [CI] 0.10 to 0.51). Scribes increased RVUs per encounter by 0.14 (95% CI 0.03 to 0.24) and RVUs per hour by 0.55 (0.30 to 0.80). There was no difference in time to disposition (5.74 minutes; 95% CI -2.63 to 14.10 minutes) or ED length of stay (-3.44 minutes; 95% CI -7.68 to 0.81 minutes), although a difference was found in clinic length of stay (5.74 minutes; 95% CI 0.42 to 11.05 minutes). Fourteen of 16 studies reported favorable provider satisfaction with a scribe. Seven of 18 studies reported favorable patient satisfaction with a scribe. No studies reported negative provider or patient satisfaction with scribes.

CONCLUSION: Overall, we found that scribes improved RVUs per hour, RVUs per encounter, patients per hour, provider satisfaction, and patient satisfaction. However, we did not identify an improvement in ED length of stay. Future studies are needed to determine the cost-benefit effect of scribes and ED volume necessary to support their use.

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Physician 5 / 7
Comments from MORE raters

Physician rater

As a physician that works with primary health care and in emergency room, I believe that this article will improve the setting where I work; the medical scribes are important for us.

Physician rater

This analysis will be helpful.

Physician rater

The addition of medical scribes of course will improve the clinical care of patients but such practice is not possible to implement in all settings and countries.

Physician rater

This extensive review demonstrates modest improvements in efficiency with the use of scribes from a time and patient satisfaction perspective. Coupled with the general improvements in the quality of documentation and provider satisfaction, scribes provide clear benefit.

Physician rater

This well done review indicates that scribes improve productivity and physician satisfaction in the ED while throughput was not impacted, that may be beyond the control of the ED and scribe (think beds available upstairs). Other literature indicates about 2 extra visits/day allows the scribe to be cost neutral in the ambulatory setting. I still worry about the loss of intimacy and a reduction in the sanctity of the physician-patient encounter.

Physician rater

Interesting, especially for very busy units.

Physician rater

These results could be very interesting for health managers.
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