Scribes

[KiloAxe]

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Wanted to get some input from docs currently using scribes. My job out of residency next year uses scribes for all physician shifts. As I have not worked directly with scribes, how do you utilize them in your practice? I understand that they can improve your documentation speed, keep you UTD on lab results, document reevaluation, consultants, and assist with discharge. But how do you get them to document the HPI appropriately without making it more time consuming for you to proofread? As physicians we are trained to consolidate the important information from patients and leave out the fluff and dangerous 'buzz' words like sudden onset for headache etc. I can dictate a HPI and ROS in 1-2 minutes and am trying to figure out how scribes will expedite this for me. Do you typically walk out of a patients room and explain how they should document the encounter or do you just proofread and edit each chart carefully?

 

[Hercules]

Scribes are like midlevels in that some of them are awesome and will drastically reduce your workload but some aren't. The first time you work with them spend a good bit of time giving them feedback. Let them know what you want documented for a normal exam. Let them know when they omit key details of the HPI and when they put irrelevant details in. This feedback over time will streamline your experience with them. After you've been working with one for 10-15 shifts they will have your preferences down and you will spend very little time documenting. Good scribes will improve your efficiency and also vastly improve your quality of life and happiness at work as you'll be able to keep seeing patients without getting 2 hrs behind on your documentation. Be happy your job has scribes.

 

[EM_Rebuilder]

My first FT job has scribes, when I started, I figured I am not going to use these folks as they will just slow me down.

Boy, was I wrong!

Its like anything, there are some that are awesome, some do fine, others suck. We usually end up getting rid of the ones that suck.

Although I skim most, there are some scribes I will almost not read anything because I do have that much trust......

As you mentioned, in addition to documentation, they are invaluable on checking on blood/urine, recheck on patients, calling consultants... and going to get us lunch!

Huge fan of scribes here; would hate to think of life without them. If I changed jobs, and there was not scribes, it could be a deal breaker to me...

 

[Greenbbs]

We have had scribes from almost the beginning of my time at my job. I'm one of my group 's more efficient docs, so I've always tended to get the more senior scribes instead of the fresh-off-the-orientation boat ones. They make a huge difference in my daily work life. I'm much more streamlined. Charts are done quickly and have all results in them. They take a cery good approximation of the history based on how I ask it, then I dictate the ros/physical to them as I'd chart it. They log all phone calls, family interactions, re-exams, etc.

They're grrrrrrreat!

 

[dotcb]

Scribes are trained to listen to a patient and condense it into a billable HPI. The experienced ones will do this well without much prompting. The new ones will overdo it and document every single symptom, and you'll have to edit and condense it. Most of them will eventually get the hang of it. Scribes are definitely great at improving quality of life. We've found that we just break even financially with them, but they make the shifts so much more palatable that they're worth using.

 

[pinipig523]

Love me them scriblets.

Especially if you have a good one... oh man... you just end up practicing medicine. It is AWESOME!!

 

[TeddyBoomBoom]

This warms my heart as I am a non-trad (35 y/o) scribe, who was recently (today) accepted into medical school.
👍

 

[Hercules]

For those of you with scribes, are you guys using an internal scribe program or are you contracting with one of the scribe staffing companies?

 

[dotcb]

We train our own. They're mostly pre-med. There is pretty predictable constant turnover.

 

[LabMonster]

Echo.

If they're good, you can kick ass and see 30-40 low-acuity pts with no sweat. If they are green, or don't have an "ear" for key parts of the H&P - you're in for more work... Good news, the good 'green' ones are typically pre-med, so they learn quickly.

 

[Groove]

We recently started using them a few months ago but it looks like we won't be using them anymore as they aren't worth the cost.

I'm probably in the minority, but I just don't care to use them. The guys that seem to get the most benefit out of them are probably ones where technical issues with the EMR or documentation entry speed is the rate limiting factor. I used them for a couple of weeks and found copious errors (more if I really started looking for them...) and also found that I could not recognize the chart or remember many of the patients. For me, there's something about writing my own HPI, in my own notation that really seals it in my memory. I also don't like the thought of placing myself at medico legal risk or downcode potential or missed RVU due to documentation error. It makes me paranoid and I found myself spending more time re-reading their documentation than it was worth. Yes, they made me feel less fatigued at the end of a shift because they can birddog results, fetch, chart, etc.. It's like having your own underling follow you around all day. That being said, I just like to be left alone and do my own thing. I find that I'm most productive and don't worry at all about my chart because I know I did 100% of it. I almost never get down coded and really strive to maximize my documentation because we are RVU driven.

Also, we contracted a group and I saw them trying to hire off Craigslist. Most are pre-med or strive to be, but some of them were just plain terrible. Your milage may vary. I've found most people swear by them and love having them around. We had a few of my colleagues that used them routinely but more than not chose not to use them for the above mentioned reasons and none of pro-Scribe guys felt strong enough to keep them although the decision was made from higher up (CMG) due to ROI not meeting target.

 

[Groove]

One more thing... I would recommend doing what I did and just not use them for a couple of weeks at your new job. See how fast you can document and move on your own so that you have a baseline comparison and then use them for the next 2 weeks. Make your decision then...

 

[deleted547339]

We train our own. They're mostly pre-med. There is pretty predictable constant turnover.

New role for third year med students? lol

 

[deleted109597]

New role for third year med students? lol

Med students can't document on Medicaid/Medicare charts. Or at least not billable ones. They can write whatever they want, we just have to redo it.

 

[link2swim06]

Med students can't document on Medicaid/Medicare charts. Or at least not billable ones. They can write whatever they want, we just have to redo it.

I heard that multiple times through third year but I lost count of the number of times my note was copy and pasted by a resident which then becomes the official note.

If we knew ahead of time that they would use our notes we would write "I am scribing for ____ resident" and then somehow it counted.

 

[deleted109597]

I heard that multiple times through third year but I lost count of the number of times my note was copy and pasted by a resident which then becomes the official note.

If we knew ahead of time that they would use our notes we would write "I am scribing for ____ resident" and then somehow it counted.

Ours aren't electronic. No copy/pasta.

Unclear on rules of medical student as scribe.

 

[TooMuchResearch]

Ours aren't electronic. No copy/pasta.

Unclear on rules of medical student as scribe.

Med students can scribe, but then they technically aren't allowed to do anything without the attending doc present. Unclear to me exactly how much med students, as scribes, can do even with the doc present. In the note, med student attests they acted as a scribe, doc attests to same with standard language about personally performing everything listed.

 

[witzelsucht]

As a scribe, thank you all for the complements. It means a lot that our work is appreciated.

To OP - after a few dozen shifts with the same scribe, if they are competent you can give very short dictations and the scribe will be able to fill in the blanks. One guy I worked with took this to an extreme (not recommended) and would come up to me and say "fast track 3 ankle inversion at soccer, its broken, she's on her way to x-ray, tell Dr. Ortho if you see him." Ability to do this will vary scribe to scribe, but we're generally smart premed types and we figure it out. In terms of work flow, a more seasoned scribe will keep in touch with charge nurse, triage nurse, and pod nurses and stay up to date on labs, x-ray reports, &tc. so we can just give you a quick 30 second summary of what we feel you need to know after coming out of a 20 minute LP or central line, especially in single coverage shops. When my doc is doing procedures and follow ups, I'll print out what I anticipate will be the DCIs for patients who are wrapping up; if he agrees we just use those, otherwise I'll be told exactly what to write. Other than that I can do simple unit clerk stuff if they are tied up, or answer simple questions from consultants if you are busy. Also we sit right next to doc, so phone calls and such go right in the MDM. You can also do a 2-for-1 deal and present a case to the consultant and scribe simultaneously to save a minute here and there. Again, small stuff but it adds up over 12 hours.

I know my medical school has an explicit ban on students acting as scribes in clinical years though, which I think is poorly thought out but whatever.

 

[Arcan57]

The financial benefit of scribes is going to be when the doc is the rate limiting step. For these shops, scribes are a no brainer. Ours are specifically trained to avoid downcoded charts, but the result tends to be an overzealous documentation of the ROS and physical exam. Even bad scribes are useful for capturing time stamps (I remember what I did for a pt, but almost never when) but the good scribes will hand you a chart that only needs a couple of corrections to sign. If you've macro'd all your typical chief complaints and you don't do re-assessment notes (which is a horrible habit) then I doubt a scribe is going to be useful to you. Otherwise, I'd consider it mandatory for any shop seeing more than 2 pts/hr.