Scribes in the ED? Choose With Care

ACEP News
April 2010

By Mary Ellen Schneider
Elsevier Global Medical News


LAS VEGAS -- With emergency physicians under pressure to improve their documentation while also working faster, scribes are becoming a potential solution in many emergency departments.

But they also pose a potential compliance risk, said Edward R. Gaines III, J.D., vice president and chief compliance officer of CBIZ Medical Management Professionals Inc. in Greensboro, N.C.

Scribes can help boost a physician's efficiency and improve charting when they stick to the model of being a "human tape recorder" who is "shoulder to shoulder with the physician," he said. The problem comes when the scribes start acting on their own, staying behind in the exam room and including elements in the documentation that were not directly noted by the treating physician.

That phenomenon is known as "mutation," Mr. Gaines said at a meeting on reimbursement sponsored by the American College of Emergency Physicians. That is most likely to occur in practices that employ physician assistant students, nurse practitioner students, and medical students as scribes. Practices that use premedical students usually have fewer problems.

Emergency medicine practices that do employ scribes should strongly consider a written scribe protocol spelling out the roles and responsibilities of the scribe. It's also important to work out any authentication issues, Mr. Gaines said.

There should be a statement in the chart or electronic medical record stating that a scribe was used, he said.

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