Hospitalist Scribes: Bane or Boon?

Hospitalist scribe: What’s that?

A hospitalist scribe is a non-clinical staff person who is trained to review charts prior to the provider’s arrival on the unit, take notes and complete documentation for the physician while s/he is rounding, and otherwise remove the burden of repetitive and time-consuming record-keeping and other non-clinical tasks. The primary duty of the hospitalist scribe is to assist in documentation tasks.

Why use a scribe?

While electronic medical records (EMRs) have great potential to facilitate the work of the entire healthcare team, physicians often find that EMRs simply mean more work, more documentation, more time away from seeing patients. This data entry work is often frustrating, time consuming, and onerous. By off-loading these tasks to qualified documentation assistants, physicians and other licensed care providers can be freed to work faster and more efficiently, with greater job satisfaction and better patient care.

At least, that is the premise. Let’s look at this concept more closely and see how it works in actual practice.

Pros:

  • Improved patient communication at bedside. Hospitalists are better able to focus on communicating well with the patient at bedside when they are not attempting to document and talk simultaneously.
  • Improved patient satisfaction. An undistracted and unhurried provider will lead to increased patient satisfaction.
  • Improved physician job satisfaction. You became a physician to help patients, not to click boxes and type notes in an electronic medical record. Having an expert assistant to do this documentation work will free you to do the patient care you love to do.
  • Lower overhead. With scribes, hospitalists can see more patients without working more hours or hiring additional physician staff. This means a lower overhead for the health system.
  • Less need to learn the ins-and-outs of multiple EMR systems. Hospitalist scribes often look up labs and results of imaging studies, relevant medical history, and other information before the hospitalist even sets foot on the unit. For hospitalists who work in multiple facilities with different EMRs, this avoids the necessity to remember where to find those pieces of information in more than one system.
  • Time saved preparing to see patients. See above. With relevant results pulled up prior to rounding on a patient, and with a computer expert to pull up any additional information that may be needed, the hospitalist can save significant time.
  • Less time writing notes after seeing a patient. Your scribe can write documentation while you are talking to the patient or giving them a running commentary during the physical exam. Thus, much of the documentation will already be done by the time you leave the room, and a short conversation after can take care of the rest.
  • Efficient order entry. Scribes can enter orders for the hospitalist to sign off on, thus saving time and effort and frustration with entering electronic orders. These are not verbal orders (which are intended to be acted on immediately) and therefore can usually be signed off for all patients at once before leaving the floor, unit, or facility.

Cons:

  • Patients may be unwilling to give sensitive information with an additional person in the room. This may make physical exams more difficult. Patients always have a right to refuse to have additional staff in the room, such as scribes or interns/students.
  • Unqualified staff acting as scribes. Inadequately trained staff, without the knowledge base necessary to clarify and question as needed, are a liability. Most medical scribes are unlicensed persons with limited training and knowledge. Therefore, their roles and duties must be clearly defined and adequate oversight provided to make sure that they are qualified and capable.
  • Unclear role and responsibilities. If roles and responsibilities are not clearly defined, scribes may end up doing work that is outside their scope (and for which they do not have the knowledge or skill to prevent errors detrimental to patient health and wellbeing). Also, unclear roles may lead to conflict and to tasks “falling through the cracks” when neither the provider nor the scribe are clearly responsible for a particular task.
  • Documentation assistants using the physician log-in rather than independently logging in to the EMR. This is a serious, but unfortunately common, occurrence. Scribes who use the physician’s login bypass the safety of having the physicians verify that the orders as entered are what was intended to be ordered. There is a potential for lawsuits around fraudulent documentation and malpractice in such cases. In addition, using the physician’s login makes it appear as though the physician is able to do more than he or she is actually capable of doing, and may affect data used to make staffing and hiring decisions.
  • Failure of physician or other licensed provider to verify orders or other documentation entered during a clinical encounter. Most often, this happens when other staff get tired of waiting for verification and override the system in some way. Most physicians are quite prompt and conscientious about verifying orders, but when they are not it creates friction and challenges for other members of the team who are then unable to provide quality care for the patients. Additionally, some providers may not review documentation for accuracy before signing off on it, leading to errors in the record and in billing and coding.
  • When no scribe is available, hospitalists may find it difficult to effectively navigate the (now even more unfamiliar) electronic health record.
  • Hospitalists may not be able to offset the cost of the scribe by bringing in additional revenue. Therefore, they may end up spending more without earning more, in the practice overall. This would eliminate any possibility for lower overhead.

Considerations and summary:

The primary reasons for hiring scribes is convenience and speed of documentation.

Not all hospitalist groups may operate in a way that makes scribes an effective addition to the team.

While some may find the convenience well worth the change and the additional supervision, others may want to keep their responsibility for documentation and research, in the interest of integrity and thoroughness.

Any decision to add scribes to a team must take into account the many variables and the quite significant pros and cons of such a change.

References and further resources:

https://www.jointcommission.org/standards/standard-faqs/hospital-and-hospital-clinics/record-of-care-treatment-and-services-rc/000002210/

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