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Scribes help ED avoid expense of hiring PAs
'Clinical information managers' mostly pre-med
The hiring of physician scribes, known as "clinical information managers," has helped Saddleback Memorial Medical Center, a five-hospital system based in Laguna Hills, CA, to save a significant amount of money by avoiding the hiring of physician assistants (PAs) for its two EDs.
"PAs cost at least $50 an hour, and we're spending $15 an hour on the clinical information managers and still surviving and getting the job done well," says Marc Taub, MD, FACEP, medical director at Saddleback Memorial ED and vice chief of staff.
This strategy was implemented several years ago, he notes. "We put it in place to try to free up physicians to have more time at the bedside and spend less time on documentation — being stuck charting," he explains. Most of the scribes are local pre-med students, Taub says.
The system has two campuses — one in San Clemente, the other in Saddleback-Laguna Hills — and those individuals are used differently in each ED, he says. In the smaller department in San Clemente, which has 15,000 annual visits, they use them to help track labs, X-ray results, and also monitor documentation to make sure they meet Centers for Medicare & Medicaid Services' requirements, core measures, and Physician Quality Reporting Initiative measures," says Taub. But in the larger Saddleback-Laguna Hills department, which has complete electronic medical recordkeeping for its 36,000 annual visits, "it's more about managing the electronic documentation phase," he says.
Managing the process
Managing the chart and the information coming into it is especially important if you don't have good interfaces with other systems, says Taub. "For example, if the lab is not automatically populating the chart, they can bring that information in," he explains. "They can also watch the trackboard."
The scribes will ask nurses about labs that are not back, so the doctor will understand the reason for the delay, says Kim Hogerson, RN, CEN, the ED manager at Saddleback. "They run around from place to place while the doctors are concentrating on the patients," she explains. "The nurses can do the same, rather than trying to track down the doctors."
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ED leader: Scribes have many benefits
When Saddleback Memorial Medical Center, a five-hospital system in Laguna Hills, CA, hired scribes for its two EDs and eliminated the need for physician assistants, it saved a significant amount of money. However, that's not the only financial benefit the EDs have realized, says Marc Taub, MD, FACEP, medical director of the Saddleback Memorial ED.
"They allow our physicians to see more patients per hour, which means more revenue," Taub says. He points out that his physicians probably see at least one more patient per hour each since the addition of the scribes.
What's more, he adds, his facilities' performance outshines some of the others in his organization. "We serve with over 50 hospitals in a large physician organization [California Emergency Physicians], and we have some of the lowest levels of down-codes in the entire organization," Taub notes. "That's definitely dollars saved."
While the scribes are used for a variety of tasks, Taub makes one important exception. "We do not use them for CPOE [computerized physician order entry]," he says. "That would probably not be the safest option."
An added benefit is that this approach provides valuable experience for the pre-med students who fill the positions, Taub says. "It's an amazing experience for them. They learn about labs and disease processes," he states. "It's a huge win-win."