Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis - 12/10/16

Doi : 10.1016/j.ajem.2016.07.056

Heather A. Heaton, MD ^a,^{^⁎} , Ana Castaneda-Guarderas, MD ^a,^b, Elliott R. Trotter, MD ^c, Patricia J. Erwin, MLS ^d, M. Fernanda Bellolio, MD ^a
^a Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
^b Knowledge and Evaluation Research Unit, Plummer 4, Mayo Clinic, 200 First St SW, Rochester, MN 55905
^c Department of Emergency Medicine, Texas Health Harris Methodist Hospital, 1301 Pennsylvania Ave, Fort Worth, TX 76104
^d Mayo Clinic Libraries, 200 First St SW, Rochester, MN 55905

^⁎Corresponding author at: Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55906. Tel./fax: +1 507 255 4399.Department of Emergency MedicineMayo Clinic200 First St SWRochesterMN55906

Abstract

Background

Scribes offer a potential solution to the clerical burden and time constraints felt by health care providers.

Objectives

This is a systematic review and meta-analysis to evaluate scribe effect on patient throughput, revenue, and patient and provider satisfaction.

Methods

Six electronic databases were systematically searched from inception until May 2015. We included studies where clinicians used a scribe. We collected throughput metrics, billing data, and patient/provider satisfaction data. Meta-analyses were conducted using a random effects model and mean differences (MDs) with 95% confidence intervals (CIs) with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.

Results

From a total of 210 titles, 17 studies were eligible and included. Qualitative analysis suggests improvement in provider/patient satisfaction. Meta-analysis on throughput data was derived from 3 to 5 studies depending on the metric; meta-analysis revealed no impact of scribes on length of stay (346 minutes for scribes, 344 minutes for nonscribed; MD −1.6 minutes, 95% CI −22.3 to 19.2 minutes) or provider-to-disposition time (235 minutes for scribes, 216 for nonscribed; MD −18.8 minutes, 95% CI −22.3 to 19.2) with an increase in patients seen per hour (0.17 more patient per hour; 95% CI 0.02-32). Two studies reported relative value units, which increased 0.21 (95% CI 0-0.42) per patient with scribe use.

Conclusion

We found no difference in length of stay or time to disposition with a small increase in the number of patients per hour seen when using scribes. Potential benefits include revenue and patient/provider satisfaction.

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Plan

Introduction

Background

Goals of this investigation

Methods

Eligibility criteria

Study selection

Data collection process and data items

Quality assessment in individual studies

Statistical analysis

Results

Risk of bias

Provider productivity

Financial impacts

Patient and provider satisfaction

Strengths and limitations

Discussion

Conclusion

☆	Presented at: accepted for oral presentation at the Society of Emergency Medicine Annual Meeting, New Orleans, LA, May 2016.
☆☆	Grant support: none.
★	Conflicts of interest: none.
★★	Author contributions: HAH, ACG, and MFB conceived the study and developed article inclusion/exclusion criteria. PJE performed the literature search. HAH and ACG developed the data extraction sheet, reviewed the literature, and performed Phase I and Phase II data extraction. MFB provided statistical advice on the study design and analyzed the data. HAH drafted the manuscript, and all authors contributed substantially to its revision. HAH takes responsibility for the paper as a whole.