Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care

Abstract

<div class="section"> <a class="named-anchor" id="d8756366e195"> <!-- named anchor --> </a> <h5 class="section-title" id="d8756366e196">Background</h5> <p id="Par1">Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. </p> </div><div class="section"> <a class="named-anchor" id="d8756366e200"> <!-- named anchor --> </a> <h5 class="section-title" id="d8756366e201">Objective</h5> <p id="Par2">Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic. </p> </div><div class="section"> <a class="named-anchor" id="d8756366e205"> <!-- named anchor --> </a> <h5 class="section-title" id="d8756366e206">Design</h5> <p id="Par3">Prospective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction. </p> </div><div class="section"> <a class="named-anchor" id="d8756366e210"> <!-- named anchor --> </a> <h5 class="section-title" id="d8756366e211">Participants</h5> <p id="Par4">Six GIM faculty and a convenience sample of their patients ( <i>N</i> = 325) at an academic GIM clinic. </p> </div><div class="section"> <a class="named-anchor" id="d8756366e218"> <!-- named anchor --> </a> <h5 class="section-title" id="d8756366e219">Main Measures</h5> <p id="Par5">A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe. </p> </div><div class="section"> <a class="named-anchor" id="d8756366e223"> <!-- named anchor --> </a> <h5 class="section-title" id="d8756366e224">Key Results</h5> <p id="Par6">Of six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session ( <i>p</i> = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65 years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present ( <i>p</i> = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe ( <i>p</i> = 0.03). </p> </div><div class="section"> <a class="named-anchor" id="d8756366e237"> <!-- named anchor --> </a> <h5 class="section-title" id="d8756366e238">Conclusion</h5> <p id="Par7">In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction. </p> </div><div class="section"> <a class="named-anchor" id="d8756366e242"> <!-- named anchor --> </a> <h5 class="section-title" id="d8756366e243">Electronic supplementary material</h5> <p id="d8756366e245">The online version of this article (10.1007/s11606-018-4434-6) contains supplementary material, which is available to authorized users. </p> </div>