Scribes: Extra help in the ER

If you have ever experienced the chaos and teamwork that is part of the emergency room, it probably wouldn’t be too difficult to understand that an extra pair of hands is usually welcome during a time of medical crisis. Medical scribes, serving as somewhat of an extension of the physician, offer help with the paperwork so that the physician can better focus on the patient.

Trinity Hospital has contracted with Scribe America, an outside company that recruits medical scribes, and currently has two medical scribes working in Trinity’s emergency room. The contract has been in effect since last October.

Dr. Jeffrey Sather, chief of medicine in Trinity’s emergency room, said as a physician, he sees and treats patients as well as documents what he has done. The paperwork aspect is a big part of what he does.

“It takes up more time than face-to-face time with the patient,” Sather said, which in turn decreases efficiency and the ability to treat the patient.

The medical scribe follows the physician around for the physician’s shift and documents the encounter with each patient the physician sees. It’s a better method, Sather said, because the documentation is done in real time. If there wasn’t a scribe, he would do the documentation later, probably toward the end of the shift. The scribe does not provide any hands-on care to patients.

“The scribe is the personal assistant or secretary for the doctor,” said Kenya Kraft, chief scribe in Trinity’s emergency room. Kraft tags along with the physician and records what happens at the physical exam and why the patient has come in for an emergency room visit. Also, she records everything that happens outside of the emergency room, like lab and x-ray results.

“It’s making sure the patient’s medical chart is as accurate as possible,” Kraft added.

Before the addition of the scribe, Sather said his day in the ER consisted of less face-to-face time with patients. “Being able to shift the documentation piece has helped,” he said. If Sather had spent an hour with a patient, half of it would have been spent documenting the visit, he continued. “Being able to shift that time gives me more time to spend with the patient.”

Medical scribes came onto the scene about the time when electronic records came into being, Sather said. Trinity Hospital switched to electronic records in 2006, he added, and were the first to make the switch. Scribes have brought back a lot of efficiency that was lost with clinical records, Sather continued. “It’s becoming a normal way of business to have scribes.”

Typically, a person working as a scribe is a college student interested in pursuing a career in the medical field. It gives the person exposure to the doctor’s thinking, you see the doctor’s interaction with patients, and it’s good exposure to the medical field, Kraft said. Training to be a scribe is heavy in medical terminology and includes classroom hours and passing a written exam.

“Not a whole lot of prior experience is necessary,” she said, “but you have to be a quick learner because there are a lot of terms to learn.”

“This is a great job for someone with interest in the medical field or wanting to go into the field,” Sather said. “It’s great to put on a resume if you’re going to medical school.”

Medical scribes are recruited mainly on college campuses or by word of mouth, Kraft said. The two scribes at Trinity are local people even though they are contracted through Scribe America.

Sather said he thinks the use of a medical scribe could probably be incorporated in other areas of the hospital, but so far they are just being used in the ER.

“The scribes have become part of the (ER) team,” he said.

Sather said they will see the return-on-investment as the scribe program continues. It’s also a benefit to the patient that the documentation is done in real time, he added, and the big benefit as a physician is that most of the notes are done by the end of the shift.

“It saves me from having a pocketful of notecards,” Sather said. “It’s a win-win for everyone.”