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抄写员能提高家庭医生的效率和工作满意度吗?

Can scribes boost FPs' efficiency and job satisfaction?

作者信息

Earls Stephen T, Savageau Judith A, Begley Susan, Saver Barry G, Sullivan Kate, Chuman Alan

机构信息

Department of Family Medicine & Community Health, University of Massachusetts Medical School, Worcester, MA, USA.

Barre Family Health Center, UMassMemorial Health Care, Barre, MA, USA. Email:

出版信息

J Fam Pract. 2017 Apr;66(4):206-214.

Abstract

PURPOSE

Research in other medical specialties has shown that the addition of medical scribes to the clinical team enhances physicians' practice experience and increases productivity. To date, literature on the implementation of scribes in primary care is limited. To determine the feasibility and benefits of implementing scribes in family medicine, we undertook a pilot mixed- method quality improvement (QI) study.

METHODS

In 2014, we incorporated 4 parttime scribes into an academic family medicine practice consisting of 7 physicians. We then measured, via survey and time-tracking data, the impact the scribes had on physician office hours and productivity, time spent on documentation, perceptions of work-life balance, and physician and patient satisfaction.

RESULTS

Six of the 7 faculty physicians participated. This study demonstrated that the use of scribes in a busy academic primary care practice substantially reduced the amount of time that family physicians spent on charting, improved work-life balance, and had good patient acceptance. Specifically, the physicians spent an average of 5.1 fewer hours/week (hrs/wk) on documentation, while various measures of productivity revealed increases ranging from 9.2% to 28.8%. Perhaps most important of all, when the results of the pilot study were annualized, they were projected to generate $168,600 per year--more than twice the $79,500 annual cost of 2 full-time equivalent scribes. Surveys assessing work-life balance demonstrated improvement in the physicians' perception of the administrative burden/paperwork related to practice and a decrease in their perception of the extent to which work encroached on their personal lives. In addition, survey data from 313 patients at the time of their ambulatory visit with a scribe present revealed a high level of comfort. Likewise, surveys completed by physicians after 55 clinical sessions (ie, blocks of consecutive, uninterrupted patient appointments; there are usually 2 sessions per day) revealed good to excellent ratings more than 90% of the time.

CONCLUSION

In an outpatient family medicine clinic, the use of scribes substantially improved physicians' efficiency, job satisfaction, and productivity without negatively impacting the patient experience.

摘要

目的

其他医学专科的研究表明,在临床团队中增加医疗文书人员可提升医生的执业体验并提高工作效率。迄今为止,关于在初级保健中引入文书人员的文献有限。为确定在家庭医学中引入文书人员的可行性和益处,我们开展了一项试点混合方法质量改进(QI)研究。

方法

2014年,我们将4名兼职文书人员纳入一个由7名医生组成的学术性家庭医学诊所。然后,我们通过调查和时间跟踪数据,衡量文书人员对医生门诊时间和工作效率、用于文档记录的时间、对工作与生活平衡的看法以及医生和患者满意度的影响。

结果

7名教员医生中有6名参与。本研究表明,在繁忙的学术性初级保健诊所中使用文书人员可大幅减少家庭医生用于图表记录的时间,改善工作与生活平衡,并获得患者的良好接受度。具体而言,医生每周用于文档记录的时间平均减少5.1小时,而各种工作效率指标显示提高幅度在9.2%至28.8%之间。也许最重要的是,将试点研究结果按年度计算时,预计每年可产生168,600美元——超过两名全职等效文书人员每年79,500美元成本的两倍多。评估工作与生活平衡的调查显示,医生对与执业相关的行政负担/文书工作的看法有所改善,且认为工作对其个人生活的影响程度有所降低。此外,313名患者在有文书人员在场的门诊就诊时的调查数据显示他们的舒适度很高。同样,医生在55次临床诊疗(即连续、不间断的患者预约时段;通常每天有2个时段)后完成的调查显示,超过90%的时间评级为良好至优秀。

结论

在门诊家庭医学诊所中,使用文书人员可大幅提高医生的效率、工作满意度和工作效率,且不会对患者体验产生负面影响。

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