I participate in a large number of CME courses each year and, in the process, have the opportunity to hear what emergency physicians from around the country are being challenged with in regard to their day-to-day practice and, frankly, it’s a broken record. Most are dealing with EDs that are busier than ever, are holding admitted patients, are being challenged with having to use EMRs (another favorite topic of mine) and are dealing with progressively longer and longer throughput times.
Throughput is the primary issue – patients staying in the ED too long for a large variety of reasons. One of these reasons may be that the emergency physicians may not be as productive as they could be. Especially if you are dealing with an EMR, it is likely that you are going slower than you did before the EMR (a colleague told me he sees three patients an hour at one hospital he works at using scribes and one patient an hour at a hospital with a comprehensive EMR and no scribes – talk about a costly EMR!!!).
So how can emergency physicians go faster? There are a lot of tricks but, by far, one of the coolest ideas is to use physician facilitators – commonly known as scribes. The term scribes, although the best one for them, implies charting – but this is too narrow a view of what they can do to make the life of a doctor not only more productive but qualitatively much better.
When I ask attendees at our conferences if they use scribes a bare handful of people reply in the affirmative – less than 5%/ And when I ask those who do use scribes to tell the others in the audience what they think about the concept, with few exceptions, you hear absolutely glowing reviews. We’ve used scribes for at least five years and I can tell you that if one of our doctors is advised that the scribe will not be in for his shift, you’ll find the doctor rocking in the fetal position in the corner sucking their thumb saying, "Oh God, Oh God!"