Impact of scribes on patient interaction, productivity, and revenue in a cardiology clinic: a prospective study
Impact of scribes on patient interaction, productivity, and revenue in a cardiology clinic: a prospective study
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DOI：
10.2147/ceor.s49010
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Kenney, William O.
中科院分区：
文献类型：
--
作者：
Bank, Alan J.;Obetz, Christopher;Kenney, William O.
目的：急诊科已开始使用记录员，以提高医生的工作效率和患者的互动能力。方法：一项前瞻性对照研究比较了心脏病诊所的标准访问(20分钟随访和40分钟新患者)和记录系统(15分钟随访和30分钟新患者)。结果：4名医生在65小时的诊疗时间内分别有129名患者使用标准护理，210名患者使用抄写员。每小时接诊人数(P<；0.001)从2.2+/-0.3增加到3.5+/-0.4(增加5 9%)，每小时工作相对值单位(P<；0.001)从3.5+/-1.3增加到5.5+/-1.3(增加57%)。患者的满意度在基线时很高，而抄写员的满意度没有变化。在一项子研究中，抄写员探视患者的直接接触时间较短(9.1+/-2.0分钟对12.9+/-3.4分钟；P<；0.01)，但(没有电脑)患者互动时间较长(6.7+/-2.1分钟对1.5+/-1.9分钟；P<；0.01)。对医生与病人互动的主观评估(1-10分)在文员访问中更高(P<；0.01)(9.1+/-0.9比7.9+/-1.1)。每名患者的直接和间接(下游)收入分别为142美元和2398美元，另外还有81名患者使用划线带来的额外收入205,740美元。结论：在心脏病诊所使用划线是可行的，改善了医患互动，并大幅提高了医生生产力和心血管系统收入。
Objective: Scribes have been used in the emergency department to improve physician productivity and patient interaction. There are no controlled, prospective studies of scribe use in the clinic setting.Methods: A prospective controlled study compared standard visits (20 minute follow-up and 40 minute new patient) to a scribe system (15 minute follow-up and 30 minute new patient) in a cardiology clinic. Physician productivity, patient satisfaction, physician-patient interaction, and revenue were measured.Results: Four physicians saw 129 patients using standard care and 210 patients with scribes during 65 clinic hours each. Patients seen per hour increased (P < 0.001) from 2.2 +/- 0.3 to 3.5 +/- 0.4 (59% increase) and work relative value units (wRVU) per hour increased (P < 0.001) from 3.5 +/- 1.3 to 5.5 +/- 1.3 (57% increase). Patient satisfaction was high at baseline and unchanged with scribes. In a substudy, direct patient contact time was lower (9.1 +/- 2.0 versus 12.9 +/- 3.4 minutes; P < 0.01) for scribe visits, but time of patient interaction (without computer) was greater (6.7 +/- 2.1 versus 1.5 +/- 1.9 minutes; P < 0.01). Subjective assessment of physician-patient interaction (1-10) was higher (P < 0.01) on scribe visits (9.1 +/- 0.9 versus 7.9 +/- 1.1). Direct and indirect (downstream) revenue per patient seen was $142 and $2,398, with $205,740 additional revenue generated from the 81 additional patients seen with scribes.Conclusion: Using scribes in a cardiology clinic is feasible, produces improvements in physician-patient interaction, and results in large increases in physician productivity and system cardiovascular revenue.