The impact of medical scribes on emergency physician diagnostic testing and diagnosis charting

Brett R. Todd; Lucas N. Nelson

doi:10.1515/dx-2021-0099

Article

The impact of medical scribes on emergency physician diagnostic testing and diagnosis charting

Brett R. Todd and Lucas N. Nelson

Published/Copyright: October 25, 2021

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From the journal Diagnosis Volume 9 Issue 2

Abstract

Objectives

Since the widespread adoption of electronic medical records (EMRs), medical scribes have been increasingly utilized in emergency department (ED) settings to offload the documentation burden of emergency physicians (EPs). Scribes have been shown to increase EP productivity and satisfaction; however, little is known about their effects on the EP’s diagnostic process. We aimed to assess what effect, if any, scribes have on EP diagnostic test ordering and their documentation of differential diagnoses.

Methods

We conducted a retrospective cohort study utilizing a chart review to compare diagnostic practices of EPs working both with and without scribes. We analyzed the number of laboratory and radiologic diagnostic studies ordered per encounter as well as characteristics of differential diagnosis documentation.

Results

Scribes did not affect laboratory studies ordered per encounter (mean 6.31 by scribes vs. 7.35 by EPs, difference −1.04; 95% confidence interval [CI] −2.34 to 0.26) or radiologic studies ordered per encounter (mean 1.49 by scribes vs. 1.39 by EPs, difference 0.10; 95% CI −0.15 to 0.35). Scribes did not affect the frequency of documenting a differential diagnosis or the number of diagnoses considered in each differential, but they were associated with higher word counts in EP differentials (mean 72.29 by scribes vs. 50.00 by EPs, mean difference 22.79; 95% CI 6.77 to 38.81).

Conclusions

Scribe use does not appear to affect EP diagnostic test ordering but may have a small effect on their documentation of differential diagnoses.

Keywords: diagnosis; diagnostic error; diagnostic process; documentation; medical scribe

Corresponding author: Lucas Nelson, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, USA, E-mail: lucasnelson@oakland.edu

Acknowledgments

Many thanks to Michelle Jankowski, MAS, for her assistance with statistical advice, data organization, and statistical analysis. Thanks also to Dr. Lihua Qu for her assistance with data collection.

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors’ Institutional Review Board (Beaumont Research Institute, IRB #2019-095) or equivalent committee.

References

1. Gellert, GA, Ramirez, R, Webster, SL. The rise of the medical scribe industry: implications for the advancement of electronic health records. J Am Med Assoc 2015;313:1315. https://doi.org/10.1001/jama.2014.17128.Search in Google Scholar PubMed

2. Gottlieb, M, Palter, J, Westrick, J, Peksa, GD. Effect of medical scribes on throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis. Ann Emerg Med 2021;77:180–9. https://doi.org/10.1016/j.annemergmed.2020.07.031.Search in Google Scholar PubMed

3. Thomas, K, Marcum, J, Wagner, A, Kohn, MA. Impact of scribes with flow coordination duties on throughput in an academic emergency department. West J Emerg Med 2020;21:653–9. https://doi.org/10.5811/westjem.2020.2.46110.Search in Google Scholar PubMed PubMed Central

4. National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care. Washington, DC: The National Academies Press; 2015. Available from: http://www.ncbi.nlm.nih.gov/books/NBK338596/ [Cited 28 Dec 2020].Search in Google Scholar

5. Lyon, C, Holmstrom, H, McDaniel, M, Serlin, D. What can a scribe do for you? FPM 2020;27:17–22.Search in Google Scholar

6. Jones, FJS, Smith, JR, Ayub, N, Herman, ST, Buchhalter, JR, Fureman, BE, et al.. Implementing standardized provider documentation in a tertiary epilepsy clinic. Neurology 2020;95:e213–23. https://doi.org/10.1212/WNL.0000000000009778.Search in Google Scholar PubMed PubMed Central

7. Hess, JJ, Wallenstein, J, Ackerman, JD, Akhter, M, Ander, D, Keadey, MT, et al.. Scribe impacts on provider experience, operations, and teaching in an academic emergency medicine practice. West J Emerg Med 2015;16:602–10. https://doi.org/10.5811/westjem.2015.6.25432.Search in Google Scholar PubMed PubMed Central

8. Bossen, C, Chen, Y, Pine, KH. The emergence of new data work occupations in healthcare: the case of medical scribes. Int J Med Inf 2019;123:76–83. https://doi.org/10.1016/j.ijmedinf.2019.01.001.Search in Google Scholar PubMed

9. Corby, S, Gold, JA, Mohan, V, Solberg, N, Becton, J, Bergstrom, R, et al.. A sociotechnical multiple perspectives approach to the use of medical scribes: a deeper dive into the scribe-provider interaction. AMIA Ann Symp Proc 2020;2019:333–42.Search in Google Scholar

10. Riches, N, Panagioti, M, Alam, R, Cheraghi-Sohi, S, Campbell, S, Esmail, A, et al.. The effectiveness of electronic differential diagnoses (DDX) generators: a systematic review and meta-analysis. PLoS One 2016;11:e0148991. https://doi.org/10.1371/journal.pone.0148991.Search in Google Scholar PubMed PubMed Central

Received: 2021-07-17

Accepted: 2021-10-06

Published Online: 2021-10-25

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Articles in the same Issue

https://doi.org/10.1515/dx-2021-0099

Keywords for this article

diagnosis; diagnostic error; diagnostic process; documentation; medical scribe