Abstract
SAN FRANCISCO: Some clinicians are turning to medical scribes to reduce the time spent managing electronic health records (EHRs). In fact, incorporating medical scribes into surgical practice increases the number of patients seen, according to research findings presented at the American College of Surgeons Clinical Congress 2019.
"We wanted to quantify how scribes could benefit patient care in surgical practice. While often employed by physicians in nonsurgical specialties, scribes are rarely seen in surgical outpatient clinics," said lead author Sirivan S. Seng, MD, who is currently a resident physician at Crozer-Chester Medical Center in Upland, Pa. "Scribes allow surgeons to focus on patient interactions while maintaining accurate documentation of their conversations with patients."
Medical scribes are professionals who document physician-patient encounters during clinical visits. They relieve physicians of the time-consuming task of patient documentation and management of electronic health records. Meticulous data entry often takes away from actual physician-patient face time and hinders a physician's ability to connect with the patient.*
The aim of this pilot study was to evaluate the impact of scribes on the workflow of two attending surgeons at an outpatient surgical oncology practice at Loma Linda University Medical Center in California.
Dr. Seng and colleagues reviewed outpatient clinic records and compared various metrics before and after medical scribes were introduced into a surgical practice. They looked at the number of operations scheduled, medications prescribed, patient wait time, time spent charting, and the number of patients seen per day.
Over four months, a total of 335 clinical encounters occurred, 183 without scribes and 202 with medical scribes. The average number of patients seen per day increased from 10 to 16. Study results also showed better resident interactions. Resident involvement in patient visits increased from 34 percent to 45 percent when assisted by a scribe.
"Our main finding was that medical scribes increased the number of patients seen per day and resident contact with patients in the clinic," Dr. Seng said.
At the same time, the level of complexity of the patients seen remained the same, the researchers found, as there were no significant differences in medications prescribed, orders placed, cases scheduled, or length of office visits, which Dr. Seng found surprising.
Furthermore, average patient wait times were similar, approximately 30 minutes, before and after the use of a scribe. Times to completion and closure of charts were shorter, but not significantly so. Dr. Seng thinks the reason the scribes did not lead to significant improvements in productivity may be due to the relatively small sample size at the time of the analysis.
"I think it's really important, from a resident perspective, that medical scribes become incorporated into the surgical practice. Not only does it benefit the attending physician but it also benefits the resident and the patient. We are all here for our patients and we want to be able to give our full time, focus, and energy to them," Dr. Seng said.
"The use of scribes could be one of the great tools that enhances physician-patient encounters and improves surgeon workflow," she concluded.
Study coauthors are Jenny H. Chang, BA; Kirollos Malek, MD; Maheswari Senthil, MD, FACS; and Sharon S. Lum, MD, FACS.
"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.
* Kimberly D Pelland, Rosa R Baier, Rebekah L Gardner. "It's like texting at the dinner table": A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals. Journal of Innovation in Health Informatics, 2017;24(2):216 DOI: 10.14236/jhi.v24i2.894.
