Dusek HL, Goldstein IH, Rule A, Chiang MF, Hribar MR. Clinical Documentation During Scribed and Non-scribed Ophthalmology Office Visits.
OPHTHALMOLOGY SCIENCE 2021;
1:100088. [PMID:
35059685 PMCID:
PMC8765735 DOI:
10.1016/j.xops.2021.100088]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE
Observe the impact of employing scribes on documentation efficiency in ophthalmology clinics.
DESIGN
Single-center retrospective cohort study.
PARTICIPANTS
A total of 29,997 outpatient visits conducted by seven attending ophthalmologists between 1/1/2018 and 12/31/2019 were included in the study; 18,483 with a scribe present during the encounter and 11,514 without a scribe present.
INTERVENTION
Use of a scribe.
MAIN OUTCOME MEASURES
Total physician documentation time, physician documentation time during and after the visit, visit length, time to chart closure, note length, and percent of note text edited by physician.
RESULTS
Total physician documentation time was significantly less when working with a scribe (mean ± SD, 4.7 ± 2.9 vs. 7.6 ± 3.8 minutes/note, P<.001), as was documentation time during the visit (2.8 ± 2.2 vs. 5.9 ± 3.1 minutes/note, P<.001). Physicians also edited scribed notes less, deleting 1.9 ± 4.4% of scribes' draft note text and adding 14.8 ± 11.4% of the final note text, compared to deleting 6.0 ± 9.1%(P<.001) of draft note text and adding 21.2 ± 15.3%(P<.001) of final note text when not working with a scribe. However, physician after-visit documentation time was significantly higher with a scribe for 3 of 7 physicians (P<.001). Scribe use was also associated with an office visit length increase of 2.9 minutes (P<.001) per patient and time to chart closure of 3.0 hours (P<.001), according to mixed-effects linear models.
CONCLUSIONS
Scribe use was associated with increased documentation efficiency through lower total documentation time and less note editing by physicians. However, the use of a scribe was also associated with longer office visit lengths and time to chart closure. The variability in the impact of scribe use on different measures of documentation efficiency leaves unanswered questions about best practices for the implementation of scribes, and warrants further study of effective scribe use.
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