An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program

Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients. 1. Introduction Emergency department (ED) overcrowding, defined as “a situation in which the demand for emergency services exceeds the ability to provide quality care within a reasonable time,” was first described nearly 20 years ago and continues to pose a significant barrier to the current day delivery of timely emergency care [1–3]. The input-throughput-output conceptual model has become widely accepted in understanding the various causes of ED crowding [4]. Patient length of stay in the ED and the inability to move admitted patients from the ED to an inpatient setting, have been identified as potential contributing factors [5]. Poor ED throughput has been linked to the following patient and provider-related outcomes: increased morbidity and mortality, increased ED financial risk secondary to the loss or revenue from patients who left without being seen (LWBS), higher malpractice risk, and lower patient/provider satisfaction scores [4]. One major way to improve patient flow within the ED is to improve the quality and efficiency of medical record documentation via the use of a Scribe Program. A 2012 study demonstrated that within 6 months of implementing a Scribe Program in an academic emergency department throughput time was reduced by 23.26 minutes