Have you worked with medical scribes?

[cipher]

Article about medical scribes in the ED.

What are your thoughts on the use of medical scribes in the ED? Overall, my experience has been positive but the inconsistency with the quality of scribes I've worked with has been frustrating.

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[RustedFox]

I had a whole thread on this:

Do your scribes suck? Do just mine suck? Do I suck? Am I doing it wrong? You tell me.

In summary, ours were so bad that we decided as a group to can them all not so long ago.

 

[cipher]

Just read through that prior thread and it sounds like many have had experiences similar to mine. I'm with you and prefer to stick with my voice dictation software.

There's also a movement towards using remote scribes, which is interesting. They put a microphone or camera in the room to monitor and transcribe the chart from a remote facility. I like the idea of not having another person following me around in the department and being present during the H&P and exam, but I'm guessing that many patients wouldn't be so comfortable knowing that there is a microphone and/or camera monitoring the evaluation. There's a medical startup called Augmedix that is using Google Glass for this purpose.

Have you had any experience with virtual scribes? I'm curious to know if it is any better than having an in-person scribe.

 

[GonnaBeADoc2222]

That's an interesting idea. I do kind of like having a buddy to go in the room with me though. Plus it's basically an automatic chaperone.

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[GeneralVeers]

That's an interesting idea. I do kind of like having a buddy to go in the room with me though. Plus it's basically an automatic chaperone.

Sent from my SM-G928V using SDN mobile

I agree with this. They are chaperone plus a witness to events in the case of a patient complaint about inappropriate conduct or language. I also use them to put the D/C instructions on the chart and get coffee. I also get them to ask patients about primary care provider, or details I have forgotten if I'm busy charting.

 

[Vandalia]

Scribes are a bit like spouses, expensive imported cars, and moonshine: If you get the right one, it can be the most wondrous experience, however, if you get a bad one, it can be hell.

The fundamental problem we had with scribes - and why we dropped the program - is that a scribe is almost by definition not content with her lot. Especially the good ones. And rightfully so. Our best scribes had their sights set on medical school, or at least some other healthcare program. The ones who would stick around, were almost always the ones who were bad at the job. So at least for us, it was a system where the best would relatively quickly leave and the worst would stick around.

Now if you had a strong undergraduate program with willing pre-med students, it might work. If you can get it to work well, it can be a great advantage for many of the reasons discussed. But for us the pain greatly outweighed the rewards. Go back to my first sentence.

 

[thegenius]

I like scribes, especially the hot ones. Get to flirt with them

OP, just go back over the past 50 posts and about 1/4 of them we invariably talk about scribes at some point. It's a mixed response.

 

[Perrin]

Personally, I'm not a fan of scribes. Our group let us try them out for a few months and decide individually if we wanted on. If you did, you had to contribute some amount to their hourly wage. That was the deal breaker for me. None of them could type fast enough to keep up with me and I typically had to go over various parts of the history or exam.

I looked at the rate limiting step in my flow in the ED. It was not my charting. It was overworked nurses. Nurse A is busy showing her student how to get med from the Pyxis, start an IV, give med X, do an EKG, document a procedure. Nurse B is busy calling report and transporting pt upstairs, so her other patient didn't get labs drawn for 45 minutes. Pt doesn't feel like she can pee and refuses a cath, so no preg test and no rads. Nurse C is at lunch, so others are covering her beds. Nurse D just got a new patient, is checking them in, and can't draw blood just yet. Lab and radiology delays. Pt's family member shows up to take her home and now wants a 15 min Q&A session on every test. The tech has to walk to pharmacy to get certain narcotics b/c the can't be tubed and aren't stocked in the ED. For me, I do pretty well keeping up with my charting. I may occasionally spend the last 20-30 minutes of my shift documenting, but I'm usually waiting on labs/rads or a consultant to call me back.

Now that it's been several months, a few of my colleagues who got scribes have talked with me about it. They don't feel it has made any change in their ability to document or their PPH. They are thinking of getting rid of them.

 

[GonnaBeADoc2222]

[QUOTE="The fundamental problem we had with scribes - and why we dropped the program - is that a scribe is almost by definition not content with her lot. Especially the good ones. And rightfully so. Our best scribes had their sights set on medical school, or at least some other healthcare program. The ones who would stick around, were almost always the ones who were bad at the job. So at least for us, it was a system where the best would relatively quickly leave and the worst would stick around.[/QUOTE]

I'm fine with the revolving door. It's a job you do before medical school / PA school. Our scribes work realllllly hard. They can't be expected to break their back for $10/hr forever. For me, even a mediocre scribe is better than no scribe as they can usually at least to click boxes and put in d/c paperwork correctly.