Our emergency medicine group, which is a large national group, contracts with a scribe company that hires, trains, and schedules scribes to work on the shifts we ask them to work. Initially, we piloted the scribe program on a partial coverage basis during our busiest shift hours, but the results were so positive that we extended coverage for 56 physician-hours a day (we staff 66 hours per day) but elected not to cover our fast-track physician with a scribe because we also employ mid­level providers in the fast track.

We initially launched the scribe program when we had T-sheet paper charting. Over the first 6 months of implementation of a scribe program, we had a volume increase of roughly 5%-6%. Our length of stay did not change, but from improved documentation, we noted a level of service improvement of 20%, an RVU/hour improvement of 15% at the site, and significant improvements in both critical care billing and procedure documentation/capture. When we went live with an EMR 21 months later, we would have expected a 20%-30% productivity decrease from the go-live process itself. But with our scribe program, we did not see any productivity decrease.

Overall, our experience with implementing a scribe program was positive. It helped our physicians build throughput capacity, as evidenced by the fact that our monthly volumes increased 20% after scribes were brought on board, but our emergency department length of stay was unchanged.

Our average door-to-doc times have also dramatically decreased from physicians not spending as much time documenting.

There has also been no need to increase physician staffing for this increased volume, nor is there a plan to do so in the short term.

Physicians have welcomed the administrative assistance that allows them to focus more on patient care than documentation. The quality of our charting has, in fact, improved as has the billing level of our charts on average. We document critical care and procedures more often, and spend more time at the bedside performing rechecks.

Some anecdotal evidence suggests that scribes have even helped with core measure compliance. For example, if a pneumonia patient receives antibiotics more than 6 hours after presentation, a scribe provides an extra checkpoint to make sure that the atypical presentation is documented.

On the downside, our physicians do have to go through and proofread the charts, and correct them as necessary. However, that consumes less time than doing all the documentation, especially for physicians who are less adept at typing in an EMR.