1. Co-Documentation: A Study on the Use of Scribes in Family Medicine Residency
William Lovett, MD, Ashley Secunda, DO
Reading Health System, Family Medicine Residency Program
Introduction
The goodness of fit tests looked at reasons for visits, gender, and language used during the visit. The goodness of fit test was to ensure that the pre and post intervention phases included similar types of patients.
P-value helps to determine the significance of results
Standard deviation essentially measures how spread out the numbers were
Results
Discussion
Group t-test: Overall
Time saved on documentation was significant.
More emphasis on patient instead of computer.
High satisfaction with scribes seen.
There was a trend towards cost savings per visit.
Time saved in the office was not significant.
Limitations:
Time –
Limited the number of recorded encounter.
Limited scribes ability to learn their physician’s documentation style.
Two scribes working with over 12 physicians.
Study was not set up to get patient feedback.
No goodness of fit measures with the physicians.
Future goals:
Examine patient satisfaction with the use of scribes.
Expand the study to include more patient encounters.
Examine physician satisfaction with the use of a scribe, but an increased patient load.
Primary care is facing challenges in:
Increasing time pressures.
Increasing regulatory/productivity demands.
Increasing documentation demands of the EHR.
Increasing physician burnout.
There have been many studies focusing on productivity improvement with the use of scribes in the emergency department and other specialty offices, but none involving primary care.
Specific Aims of the study:
Study the effect of scribes on office visit flow/cost and physician documentation time.
Evaluate physician satisfaction with the use of a scribe.
Potential benefits of the study:
Improved physician satisfaction.
Improved providers interaction with the patient.
Lower documentation time of the physician.
Improve utilization of physician expertise.
Lower visit costs.
Group t-test: Attendings
Group t-test: Residents
This is the data specially for attendings. Although over a minute of time spent documenting outside of office hours was saved with the scribe, it was not statistically significant probably because there were not enough numbers recorded
Residents spent 2 minutes less documenting outside of the office with the use of a scribe. This is statistically significant
Physician Satisfaction
Methods
References
Results are overwhelmingly positive with the use of scribes. Recall from before that 4 is agree and 5 is strongly agree
Time study on a face to face interaction of patient with staff.
Split up into 2 phases: timed visits without a scribe and timed visits with a scribe.
120 patients in both control and intervention phases.
Intervention phase introduced the use of scribes.
Third year residents and faculty physicians were studied.
A physician satisfaction survey was made using a Likert scale (1-5) format. Satisfaction was expressed on a scale from strong disagree to strongly agree.
Confidentiality and safety:
Staff data was confidential and anonymous.
Scribes only entered patient rooms with consent of the patient.
No patient clinical data was included in the study.
Scribes:
Trained through Albright College.
3 week training course with internship in Reading Emergency Department.
Entered HPI, ROS, and physical exam into the medical record.
Statistics:
All data was entered into an Excel sheet.
Goodness of fit tests regarding patient variables.
P-values of group t-tests with significant level chosen to be of 0.05.
Means and standard deviations.
Accessed April 23, 2015.
Hultman, Jon, DPM. "Would Your Practice Benefit from a Medical Scribe?" The Last Word In Practice Economics. Podiatry Management, Sept Ebscohost. Apr
Koshy S, Feustael PJ, Hong M, et al. Scribes in an ambulatory urology practice: patient and physician satisfaction. J Urol Jul; 184(1):
Arya R, Salovich DM, Ohman-Strickland P, et al. Impact of scribes on performance indicators in the emergency department. Acad Emerg Med May; 17(5):
Goodness of Fit Measures
These ensured that there was no discrepancy between the patients seen in the control and intervention phases. We wanted the p-value to be greater than 0.05 to show that the results were not significant. There were more spanish speaking patients in the intervention phase which may slowed communication down between doctor and patient thereby adding more time.
Contact information
Anonymous Physician
Reading Hospital Family Medicine Residency
Suite 200 Doctors Office Building
301 S. Seventh Ave
West Reading, PA 19611