Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
J Gen Intern Med. 2018 Jul;33(7):1109-1115. doi: 10.1007/s11606-018-4434-6. Epub 2018 Apr 26.
Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care.
Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic.
Prospective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction.
Six GIM faculty and a convenience sample of their patients (N = 325) at an academic GIM clinic.
A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe.
Of six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session (p = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65 years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present (p = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe (p = 0.03).
In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.
电子健康记录（EHRs）的使用与医生的压力和倦怠有关。虽然急诊部门和专科医生已经使用抄写员来解决这个问题，但在学术性初级保健中，抄写员的影响知之甚少。
评估学术性普通内科（GIM）诊所抄写员对医生和患者满意度的影响。
前瞻性、预-后试点研究。在 3 个月的试点期间，医生在有和没有抄写员的情况下进行诊所就诊。我们评估了以下方面的变化：（1）医生工作场所满意度和倦怠感，（2）在 EHR 文档记录上花费的时间，以及（3）患者满意度。
6 名普通内科教员和他们在学术性普通内科诊所的方便样本患者（N=325）。
在试点前和试点后使用包含 21 个项目的调查问卷评估医生工作场所满意度和倦怠感。医生使用日志记录在诊所外时间在 EHR 文档记录上花费的时间。在有和没有抄写员的就诊后使用包含 27 个项目的调查问卷评估患者满意度。
在 6 名医生中，100%的人对试点后的诊所工作流程感到满意（与试点前的 33%相比），83%的人对试点后的 EHR 使用感到满意（与试点前的 17%相比）。医生的倦怠感在基线时较低，试点后没有变化。每次诊所就诊后在诊所外记录 EHR 的时间从 1.65 小时减少到 0.76 小时（p=0.02）。患者满意度在有和没有抄写员的就诊患者之间总体上或按年龄、性别和种族没有差异。与 65 岁或以上的患者相比，年轻患者更有可能报告在有抄写员在场的就诊中，医生更专注，提供了更多的教育（分别为 p=0.03 和 0.02）。男性患者更有可能报告他们不喜欢有抄写员（p=0.03）。
在学术性 GIM 环境中，雇用抄写员与提高医生满意度有关，同时不会降低患者满意度。
