6 Financial Impact of Scribes in an Academic Emergency Department

Abstract

Interest in scribe programs and their implementation in emergency departments (EDs) have grown considerably since they were first implemented in the early 1990s. Several publications describe the financial advantages to scribes, both in the community ED and out-patient clinic setting; however, there is limited information regarding the fiscal impact of a scribe program in an academic emergency medicine department. The University of North Carolina (UNC) Department of Emergency Medicine provides care to approximately 72,000 patients annually, with an admission rate of just below 30 percent. UNC is a certified level 1 trauma center, state burn center and TJC comprehensive stroke center with 30 total emergency medicine residents. Given the limited data on scribes in an academic setting, we implemented a scribe pilot program in March 2013 to evaluate the financial impact of scribes. For this study, June 2013 charts were examined retrospectively. Scribes were assigned to a PGY-2 physician, PGY-3 physician, nurse practitioner (NP), or an attending provider during an eight-hour shift during the busiest time of the day. To measure the impact of scribes on revenue, charts were broken into two groups consisting of patients seen with a scribe (n=461) and those seen without a scribe (n=744). Financial data collected included wRVUs and date of service (DOS) to time until the bill is finalized for the patient. Statistical analysis was done using a two-tailed T-test and with P values ≤ 0.05 considered statistically significant. In our study a total of 1,205 patient charts were reviewed. We analyzed data in several groups, including all charts for the month as well as in cohorts divided by level of provider training (3rd year residents, 2nd year residents, 1st year residents, NPs, attending only, and other care providers including medical students). Scribes did not significantly increase wRVUS when all providers were considered together (P=0.9056); however, they did show significance when charts for 3rd-year residents and patients seen only by attendings were evaluated separately (P=0.0006 and 0.0394 respectively). Further, significant decrease in DOS to the finalized patient bill was observed when scribed charts were compared to charts completed without scribe utilization (P=0.000). With senior residents and attending physician charts, significant increases in wRVUS were seen suggesting that scribes allowed for more complete documentation of the higher acuity patient population normally seen by these two groups of providers at our facility. Equally important, scribes allowed for timelier billing, suggesting quicker completion of charts. Limitations include the length of time evaluated and the use of an institution-funded, recently implemented scribe program to conduct this study. Additionally, data collected reflects provider performance only two months after scribe program implementation; time is required to allow scribes to mature into their roles as well as for providers to learn the best way to utilize them. As the use of scribes continue within the department and more physicians become familiar with their skill set, further studies will be conducted to determine the true financial impact of scribes in the academic setting.