Assessing the Impact of Scribe Use on a Pediatric Urgent Care Department One Year Postimplementation.

Abstract

Purpose: To research the feasibility and potential benefits of scribe use in a Pediatric Urgent Care setting. Hypothesis: Scribe use will help decrease patient length of stay(LOS), improve provider satisfaction, improve patient satisfaction, and decrease number of patients who left without being seen(LWBS). Background/Significance: Little data exists researching the feasibility or benefits of scribes in clinical care settings. Existing data analyzing scribe use in these settings is limited to that of emergency rooms and primary care. This study focused on the impact of scribe use in a hospital based pediatric urgent care clinics with four sites, three of which implemented scribes and one that did not. Methods: The pre-post scribe implementation study design included the following quality metrics, namely (1) provider satisfaction as provided by third-party National Research Corporation, Health, (2) nursing satisfaction as provided by third-party National Research Corporation, Health, (3) provider attrition as collected from the hospital’s internal Mireaux Management Solutions system, (4) patient satisfaction, as measured through hospital based Family Experience Survey(FES) scores, (5) number of patients who left without being seen(LWBS), and (6) patient length of stay(LOS). The second design was an observational design that compared the three sites utilizing scribes(S, M, B) to a control site without scribes(F). Metrics collected included (1) patients who left without being seen(LWBS) and (2) patient’s length of stay(LOS). Data Analysis: The study data collection period ranged from October 2015 through May 2017. Data extraction was conducted from 33,335 patient encounters pre-scribe implementation, and 36,841 patient encounters in the post-scribe cohort. Quality metrics 1, 2, and 3 were measured descriptively, without the use of statistical analysis. Metrics 4 and 5 were evaluated using Chi-square tests. To test for significance of relationship, p-values with confidence intervals were reported. P-values <0.05 were considered significant and 95% binomial proportion confidence intervals were reported. Statistical analyses were performed using Stata version 14.224. Results: Scribe use was associated with improvements in scores for provider satisfaction (average improvement of 3.52 pre-scribe to 4.07 post-scribe) and decreased provider turnover (45% to 12%). Scribe use was also associated with improvements in scores for nursing satisfaction (average improvement of 3.54 pre-scribe to 3.76 post-scribe). Additionally, improvements in scores for patient satisfaction (averaged 87.63 pre-scribe to 88.01 post-scribe) were also seen with scribe use. Statistically significant decreases in patients who Left-Without-Being-Seen(LWBS) were observed in the S (p-value: 0.049; Δ%: 0.21; CI: (0.00,0.41)) and M locations (p-value: 0.03; Δ%: 0.23; CI: (0.02,0.43)), with no statistically significant improvement observed at the F location (p-value: 0.975; Δ%: 0.00; CI: (-0.19,0.19)) and an increase in patients who LWBS at the B location (p-value: 0.601; Δ%: 0.07; CI:(-0.32,0.18)). No statistical significance was observed when S (p-value: 0.911; Δ%: 0.01; CI: (-0.19, 0.17)) and M ((p-value: 0.741; Δ%: 0.03; CI: (-0.21, 0.15)) locations were compared to the F location, the site without scribes. In the pre-post implementation study, statistically significant decreased Patient Length-Of-Stay(LOS) was observed in both <60 minute and <90 minute categories at all locations (28% to 34% length of stay less than 60 min; 54% to 65% length of stay less than 90 min). Statistically significant comparisons were also found when two of the three scribe use sites were compared to the F location. Discussion: In a pediatric urgent care setting, scribe use appears to have a limited impact on patient related metrics. While utilization was associated with increased provider satisfaction, nursing satisfaction, patient satisfaction, and appeared to reduce patient length of stay; scribe use does not significantly impact the number of patients who left without being seen. Conclusions: Overall quality and throughput metrics were not significantly enhanced by scribes, despite improvements in overall provider and patient satisfaction. The cost of implementing and maintaining a scribe program may not be justified on a purely financial basis, but may enhance provider satisfaction and retention.