Transcription services in the ED.

This study's objectives were to determine the cost-effectiveness of introducing a transcription service into an emergency department (ED) and to determine the capacity of such a service to improve physician satisfaction. A prospective study of full-time emergency physicians was conducted in the ED of a community hospital in which a transcription service was introduced during peak periods of demand. Measurement was defined from a time-and-motion study consisting of direct observation by an industrial engineer who measured documentation time required for written and dictated charts. Surveys examined satisfaction with each record type among the emergency and non-emergency medical staff. It was found that dictation of the medical record was notably faster than writing (155 seconds compared with 220 seconds per record, P = .0002) for all physicians examined. Total productivity of the department improved by 3.8% (from 2.20 patients per physician-hour to 2.28 patients per physician-hour), calculated from patient volumes of 7,355 and 7,075 with the same staff (P < .05). When the records were transcribed, the mean subjective scores for satisfaction with the medical record improved from 2.1 to 3.6 (P = .0025) on a scale of 1 to 4. Surveys of nonemergency staff physicians documented that legibility score improved from 2.6 to 3.1 (P = .0056) and completeness improved from 2.6 to 3.0 (P = .0157), both on a scale of 1 to 4. It was concluded that dictating and transcribing ED medical records decreases the time required for documentation, improves record legibility and quality, allows more patients to be seen per physician-hour, and improves the satisfaction of emergency and nonemergency physicians.