February 2003

Emergency Department Scribes Increase Quality, Savings


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"The university should continue to be a great source of candidates for the scribe program, and having this relationship with the pre-medicine program there is very valuable to Memorial." Jerry Bishop, Performance Improvement Representative, Memorial North Park Hospital

In just six months, the Emergency Department Scribe Program at Memorial North Park Hospital in Chattanooga, Tenn., has reduced coding turnaround time by 34 percent, which translates to thousands of dollars in annual savings and increased reimbursements. Since last summer, the hospital’s emergency department has made the services of a trained scribe available to physicians during peak hours. The scribe essentially acts as a physician’s dictation system, completing all necessary paperwork as the physician examines patients. "The completeness, accuracy and legibility of the documentation created by the scribes means that our coders don’t have to spend time gathering missing information," said Jerry Bishop, performance improvement representative for Memorial North Park. The additional documentation the scribes provide has a positive effect on the emergency department’s compliance rate for medical necessity. Also, while hospital coders give emergency department physicians’ handwriting a four on a scale of one to 10, they give the scribes a 10. "The legibility and completeness of the documentation also improves patient care and safety," said Milt Hammerly, MD, director of integrative medicine for Catholic Health Initiatives. "It makes changes of shift in the emergency department and transfers of patients to other floors of the hospital go much more smoothly." Hammerly had the idea to develop a scribe program after reading about the potential financial and clinical benefits. Memorial expressed interest in the idea and assembled a project team that included physicians, nurses and risk managers. One of the team members had visited an emergency department in Williamsburg, Va., that uses scribes. The team contacted the Williamsburg hospital, which agreed to provide training to the staff at Memorial North Park Hospital, which has about 2,000 emergency room visits per month. "We originally thought that people with coding experience would make the best scribes, but the Williamsburg team had more success with pre-medicine students," said Hammerly. The Memorial team contacted the pre-medicine program at the University of Tennessee at Chattanooga and received more than 30 applications from interested students. The team selected four students to be trained as scribes, based on their handwriting legibility and background in medical terminology. The trainees completed two weeks of classroom instruction in medical terminology, commonly used acronyms and Memorial’s documentation systems. "The university should continue to be a great source of candidates for the scribe program, and having this relationship with the pre-medicine program there is very valuable to Memorial," said Bishop. Memorial North Park’s emergency department physicians went through a period of adjustment to the scribe program. "They had to learn to say what they were thinking as they think it," said Bishop. "The fact that they don’t have to catch up on documentation after seeing emergency patients, which poses the risk of losing some information, is a great advantage." While Catholic Health Initiatives provided start-up funding for the program, the savings generated will sustain it in the future, said Harold Ray, MD, chief medical officer for Catholic Health Initiatives. For more information about the Emergency Department Scribe Program, contact Milt Hammerly at milthammerly@CatholicHealth.net.