Emergency Department Setting:

  • Trauma Center/Tertiary Care Hospital for multiple-county area
  • 60,000 annual ED visits
  • 28 ED beds

Challenge:

  • Increase physician productivity (ACEP estimates 90 to 120 minutes of an 8-hour emergency physician’s shift is spent on documentation)1
  • Increase physician staff satisfaction/retention
  • Free physician to focus on patient care rather than documentation

Solution:

  • Designated ESP emergency physician as ESP Scribe Program Coordinator
  • Program Coordinator developed relationship with area university to develop “prospective scribe pool”
  • Efforts focused on pre-med, dental, PA, nursing students, etc. off for semester or year
  • Developed scribe credentialing process with hospital:
    • ESP Scribe Program Coordinator personally interviewed candidates
    • Performed background checks
    • Developed scribe rules and conduct for review and signature
    • Administered medical terminology exam
    • Obtained ED/Hospital IS access for approved scribes via hospital
    • Hospital provided HIPPA video for all scribes to review
    • Offered hands-on training
  • Trained ESP emergency physicians on scribe utilization:
    • Strict rules of “scribe dos and don’ts”
    • Physician verbal cues and citing of history, physical exam findings, and other data to scribe

Results:

  • An increase in emergency physician productivity of 17.3% in the main ED (exclusive of minor patients seen in a separate express care/fast track)
  • Physician shifts with scribe decreased turn-around times 20 minutes per patient while at the same time ED volume increased and hit hospital record highs
  • Significant decrease in patients who leave without being seen (LWBS)
  • Backdated charts decreased by 95%
  • Positive individual patient comments and increase in overall patient satisfaction scores
  • Increased physician satisfaction

Figure 1. Emergency Physician Productivity Increase (Non-Express Care Volume)

Case-Study-6-Fig-1

1 ACEP Task Force Report on Boarding, “Emergency Department Crowding: High-Impact Solutions,” April 2008