What Do Scribes Do?

ED scribes perform a variety of functions with the ultimate goal of maximizing the physician’s workflow efficiency. Emergency physicians are faced with a tremendous cognitive load, often requiring moment-to-moment decisions and actions to move patient care forward. Each additional task, from ordering tests to documenting the history and physical exam, adds a level of complexity to the health care setting, increases patient ED length of stay, and increases the risk of medical errors by creating more opportunity for the physician to miss something. The constant interruptions in an emergency physician’s workflow put patient care at risk.

Studies have shown the time spent by the average emergency physician in documentation, especially in an electronic medical record (EMR), to be roughly 30%-40% of the overall time on shift. A well-trained ED scribe can be a tremendous resource by handling all of the documentation and related workflow management tasks. The scribe follows the emergency physician into patient’s rooms, documenting pertinent positive and negative elements of the history and physical exam findings as dictated by the physician. They document vital signs and keep track of lab values and radiology results. They can pull pertinent past medical records, enter discharge information, compose work excuse notes, and even write prescriptions to be signed off by the physician. Scribes can document when consultants were paged and called back, enter findings from re-exams, and limit interruptions by taking information from support staff in the department to the emergency physician.

In sum, by handling these adjunct tasks for which physicians have been traditionally responsible, the scribe frees the physician to increase patient contact time, give more thought to complex cases, better manage patient flow through the department, and increase productivity to see more patients.

Scribes are also trained in risk management to avoid potential documentation pitfalls (e.g., when to document “worst headache of my life” and, perhaps more importantly, when not to). They are often trained in billing and coding issues related to documentation so they can give the chart an appropriate level of completion to ensure appropriate billing for a patient encounter. They also focus on pertinent details that the physician can overlook on a busy shift, such as documenting procedures, rechecks, and critical care time.

How Much Do Scribes Cost?

Figures for scribe costs vary widely and depend on the labor arrangements at individual sites. Some physicians elect to hire and train scribes on an individual basis, where the hired scribes will work exclusively with that physician. Some physicians (depending on practice environment factors such as ED volume, EMR availability, ED culture, reimbursement, etc.) elect to have multiple simultaneous scribes to help them manage high patient throughput as safely as possible. Many ED physician groups will contract with medical scribe companies that train their scribes in-house and deploy them to the physician group to cover an agreed-upon number of physician hours.