Reduced Cognitive Burden and Increased Focus

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.

Trends, Distribution, and Impact of Pediatric Messages in a Large Health System From 2019 to 2021

“…Within groups, time on the EHR outside clinical hours did not increase, perhaps because visits decreased. As office visits rebound, health systems may need to support pediatricians’ ability to handle their workload by charging for messages, dedicating time to responding, offering scribes, or adjusting panel sizes. The small sample and inability to differentiate how time was spent on the EHR are limitations.…”

Interventions to Reduce Electronic Health Record-Related Burnout: A Systematic Review

“…Fourteen studies measured the baseline burnout or wellness level of the participants as well as the outcomes of the interventions. These included the Mini-Z survey, 30,38,46,48 Maslach Burnout Inventory, 50,57,61 Professional Fulfillment Index, 31,48,51,59 American Medical Association Steps Forward Survey, 26,48 Copenhagen Burnout Inventory, 44 and physician work-life study study, 45 and the Stanford Physician Wellness Survey. 42,45 For intervention satisfaction, written surveys 20-25,28,29 32-37,40,41,43,47-49,52,53,55,56,60,63 was most often used, followed by Net Promoter Score (NPS), 39,45,57,62 and the Technology Acceptance Model sub-survey.…”

“…Interventions to reduce EHR-related clinician burnout were in three broad groups: (1) employment of scribes (48%), 23,[26][27][28]31,[34][35][36]41,44,[46][47][48][49][50][51][52][53]56,59,60 (2) EHR training (36%), 20,25,29,30,33,[37][38][39][40]42,43,45,55,57,58,61 and (3) EHR modifications (25%) [20][21][22]24,32,39,54,57,58,62,63 (►Table 3). Four studies combined both EHR training and modifications into one intervention (9%; ►Fig.…”

“…The most common intervention to reduce EHR-related clinician burnout was the use of scribes. Most used in-person scribes, 23,[26][27][28]31,[34][35][36]41,44,46,47,[49][50][51][52][53]56,60 whereas two studies described the use of virtual scribes. 48,59 All studies described the use of scribes by physicians, although four studies also included APPs.…”

“…48,59 All studies described the use of scribes by physicians, although four studies also included APPs. 44,46,50,51 In-person scribe programs involved a scribe accompanying the clinician into the patient room and documenting the patient encounter in real time. 56,60 For virtual scribe programs, a scribe working in a remote location would listen to the patient interaction and enter clinical information into the EHR real time or asynchronously.…”