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. 2022 Apr 1;60(4):316-320.
doi: 10.1097/MLR.0000000000001688.

Reduced Cognitive Burden and Increased Focus: A Mixed-methods Study Exploring How Implementing Scribes Impacted Physicians

Elizabeth R Pfoh  1   2 , Sandra Hong  3 , Laura Baranek  2 , Michael B Rothberg  1   2 , Sarah Beinkampen  4 , Anita D Misra-Hebert  1   2   5 , Susan J Rehm  6 , Andrea L Sikon  1   2   5
Affiliations

Reduced Cognitive Burden and Increased Focus: A Mixed-methods Study Exploring How Implementing Scribes Impacted Physicians

Elizabeth R Pfoh et al. Med Care. .

Abstract

Background: Understanding how medical scribes impact care delivery can inform decision-makers who must balance the cost of hiring scribes with their contribution to alleviating clinician burden.

Objective: The objective of this study was to understand how scribes impacted provider efficiency and satisfaction.

Design: This was mixed-methods study.

Participants: Internal and family medicine clinicians were included.

Measures: We administered structured surveys and conducted unstructured interviews with clinicians who adopted scribes. We collected average days to close charts and quantity of after-hours clinical work in the 6 months before and after implementation using electronic health record data. We conducted a difference in difference (DID) analysis using a multilevel Poisson regression.

Results: Three themes emerged from the interviews: (1) charting time is less after training; (2) clinicians wanted to continue working with scribes; and (3) scribes did not reduce the overall inbox burden. In the 6-month survey, 76% of clinicians endorsed that working with a scribe improved work satisfaction versus 50% at 1 month. After implementation, days to chart closure decreased [DID=0.38 fewer days; 95% confidence interval (CI): -0.61, -0.15] the average minutes worked after hours on clinic days decreased (DID=-11.5 min/d; 95% CI: -13.1, -9.9) as did minutes worked on nonclinical days (DID=-24.9 min/d; 95% CI: -28.1, -21.7).

Conclusions: Working with scribes was associated with reduced time to close charts and reduced time using the electronic health record, markers of efficiency. Increased satisfaction accrued once scribes had experience.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Overhage JM, McCallie D. Physician Time Spent Using the Electronic Health Record During Outpatient Encounters: A Descriptive Study. Ann Intern Med. 2020;172(3):169. doi:10.7326/M18-3684 - DOI - PubMed
    1. Toscano F, O’Donnell E, Broderick JE, et al. How Physicians Spend Their Work Time: an Ecological Momentary Assessment. J GEN INTERN MED. Published online August 17, 2020. doi:10.1007/s11606-020-06087-4 - DOI - PMC - PubMed
    1. Sinsky C, Colligan L, Li L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016;165(11):753. doi:10.7326/M16-0961 - DOI - PubMed
    1. Adler-Milstein J, Zhao W, Willard-Grace R, Knox M, Grumbach K. Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. Journal of the American Medical Informatics Association. 2020;27(4):531–538. doi:10.1093/jamia/ocz220 - DOI - PMC - PubMed
    1. Degen C, Li J, Angerer P. Physicians’ intention to leave direct patient care: an integrative review. Hum Resour Health. 2015;13:74. doi:10.1186/s12960-015-0068-5 - DOI - PMC - PubMed

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