Impact of a medical scribe on clinical efficiency and quality in an academic general internal medicine practice

BMC Health Services Research

Deborah L. Burnet¹  Neda Laiteerapong¹  Felipe Fernandez del Castillo¹  Sachin Shah¹  Wei Wei Lee¹  Anastasia Pozdnyakova Piersa²  Sandra A. Ham³ 

[1] Department of Medicine, University of Chicago, Chicago, IL, USA;Pritzker School of Medicine, University of Chicago, Chicago, USA;University of Chicago Center for Health and the Social Sciences, Chicago, USA;

关键词: Scribe;    Electronic health records;    Primary care;    Clinical efficiency;    Quality of care;   

DOI  :  10.1186/s12913-021-06710-y

来源: Springer

【 摘 要 】

BackgroundScribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. We aimed to assess the impact of a scribe on clinical efficiency and quality in an academic internal medicine practice.MethodsSix faculty physicians worked with one scribe at an urban academic general internal medicine clinic April through June 2017. Patient visits during the 3 months prior to intervention (baseline, n = 789), unscribed visits during the intervention (concurrent control, n = 605), and scribed visits (n = 579) were included in the study. Clinical efficiency outcomes included time to close encounter, patient time in clinic, and number of visits per clinic session. Quality outcomes included EHR note quality, rates of medication and immunization review, population of patient instructions, reconciliation of outside information, and completion of preventative health recommendations.ResultsMedian time to close encounter (IQR) was lower for scribed visits [0.4 (4.8) days] compared to baseline and unscribed visits [1.2 (5.9) and 2.9 (5.4) days, both p < 0.001]. Scribed notes were more likely to have a clear history of present illness (HPI) [OR = 7.30 (2.35–22.7), p = 0.001] and sufficient HPI information [OR = 2.21 (1.13–4.35), p = 0.02] compared to unscribed notes. Physicians were more likely to review the medication list during scribed vs. baseline visits [OR = 1.70 (1.22–2.35), p = 0.002]. No differences were found in the number of visits per clinic session, patient time in clinic, completion of preventative health recommendations, or other outcomes.ConclusionsWorking with a scribe in an academic internal medicine practice was associated with more timely documentation.

【 授权许可】

CC BY