Effect of Scribes on Efficiency in Academic Ophthalmology Practice

Abstract

Objective The aim of the study is to determine the effects of scribes on efficiency in an academic ophthalmology practice. Design This is a quality improvement study conducted by two ophthalmologists at an academic ophthalmology practice at UT Health San Antonio from January 2018 to April 2018. Implementation of scribes in practice was the primary intervention. Session time, patient encounter time, and template time adherence were recorded pre- and post-intervention. A second retrospective arm of the study at the same institution was performed to evaluate long-term effects of scribes on efficiency in ophthalmology practice on session times and patient volume 12 to 18 months after intervention. Main Outcome Measures Primary study outcomes and measures were the effect of scribes in academic ophthalmology practice on physician efficiency in terms of clinic session time, individual encounter time, and amount of patients seen per session, in addition to time adherence based on type of patient encounter. Results Eighty-three patients and 17 half-day clinic sessions and 169 patients and 21 half-day clinic sessions were included in the preintervention and post-intervention datasets, respectively. Number of patients per session was approximately 15 and was kept similar pre- and post-intervention (p = 0.45). Mean preintervention session time was 265.0 ± 31.4 minutes, in contrast to 223.4 ± 19.9 minutes after intervention (p < 0.001). Mean preintervention patient encounter time was 15.0 ± 8.3 minutes, while the mean encounter time after intervention was 10.9 ± 7.0 minutes (p < 0.005). In a retrospective analysis of 20 clinic sessions and 438 patients 12 to 18 months after intervention, session time increased to 266.0 ± 22.0 minutes on average, but the average number of patients per session increased to 21.9 ± 2.8 minutes. Conclusion Utilizing scribes in an ophthalmology practice can increase efficiency, allowing more patients to be seen or allowing time for other activities such as teaching or research.

Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics

“…Our findings in the VA setting are consistent with previous non-VA studies that found associations between scribe intervention and increased productivity. 8 , 13 – 15 In our study, randomization to the scribe pilot was associated with improved productivity when measured as visits per FTE and RVUs per FTE, but not patients per day per provider, which may be a result of the lack of FTE adjustment in that measure. Although scribes’ assistance may increase providers’ availability in the clinic and reduce wait times, 22 , 33 , 34 providers’ scheduling patterns and administrative staff support are also key to reducing wait times.…”

“…Evidence from past studies suggests that the use of medical scribes may be associated with increased productivity in a variety of clinical settings, although not uniformly. Studies found that scribes may be associated with increased provider productivity measured by the number of patients seen per hour or relative value units (RVUs) per hour in primary care, 8 – 12 specialty care, 13 – 16 and emergency department settings. 17 – 19 Only a few studies have examined the impact of scribes on provider satisfaction, time spent on documentation, time spent face-to-face with patients, and patient satisfaction.…”