Evaluation of Medical Scribes’ effect on the Emergency Department’s productivity - A before-after cohort study

Abstract Background: Emergency department length of stay is increasing in Sweden. One contributing factor for the accelerating emergency department length of stay, is the rise in administrative workload on the physicians. Prolonged patient waiting time and overcrowding leads to an unsafe environment. The aim of this study was to evaluate whether the productivity of physicians at the emergency department of Kungälv hospital increased following the introduction of medical scribes. Method: We conducted a before-after study during 39 days at an emergency department. Data were collected from shifts worked by physicians with different work experience and medical specialties during two different summer periods, one period with medical scribes and the other without medical scribes. All patients visiting the emergency department and requiring healthcare during the period of medical scribes’ presence, were eligible. Patients were excluded from the study if they denied the presence of a medical scribe, or if the physician refused the medical scribe’s presence. We measured the physicians’ productivity by evaluating the mean number of assessed patients per hour per physician. Independent Samples t-test was used for statistical analysis. Result: We documented a total of 584 physician-hours with a medical scribe and 584 hours without a medical scribe. A total number of 463 patients was assessed with a medical scribe during the period of 2018 compared to 362 patients assessed without a medical scribe in 2017. The physicians assessed significantly larger number of patients per hour with the assistance of a medical scribe, an increase of 0.22 (36%) patients per hour per physician, from 0.61 to 0.83 patients per hour per physician (95% CI 0.13-0.30). Conclusion: We conclude that scribes do improve physicians’ productivity by increasing the number of assessed patients per hour per physician.