• Sivagaminathan Palani, Iman Saeed, Aaron Legler, Izabela Sadej, Carol MacDonald, Susan R Kirsh, Steven D Pizer, and Paul R Shafer.
• Partnered Evidence-based Policy Resource Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts. Electronic address: spalani@bu.edu.
• J Emerg Med. 2024 Jul 1; 67 (1): e89e98e89-e98.

BackgroundTo help improve access to care, section 507 of the VA MISSION (Maintaining Internal Systems and Strengthening Integrated Outside Networks) Act of 2018 mandated a 2-year trial of medical scribes in the Veterans Health Administration (VHA).ObjectiveThe impact of scribes on provider productivity and patient throughput time in VHA emergency departments (EDs) was evaluated.MethodsA clustered randomized trial was designed using intent-to-treat difference-in-differences analysis. The intervention period was from June 30, 2020 to July 1, 2022. The trial included six intervention and six comparison ED clinics. Two ED providers who volunteered to participate in the trial were assigned two scribes each. Scribes assisted providers with documentation and visit-related activities. The outcomes were provider productivity and patient throughput time per clinic-pay period.ResultsRandomization to intervention resulted in decreased provider productivity and increased patient throughput time. In adjusted regression models, randomization to scribes was associated with a decrease of 8.4 visits per full-time equivalent (95% confidence interval [CI] 12.4-4.3; p < 0.001) and 0.5 patients per day per provider (95% CI 0.8-0.3; p < 0.001). Intervention was associated with increases in length of stay of 29.1 min (95% CI 21.2-36.9 min; p < 0.001), 6.3 min in door to doctor (95% CI 2.9-9.6 min; p < 0.001), 19.5 min in door to disposition (95% CI 13.2-25.9 min; p < 0.001), and 13.7 min in doctor to disposition (95% CI 8.8-18.6 min; p < 0.001).ConclusionsScribes were associated with decreased provider productivity and increased patient throughput time in VHA EDs. Although scribes may have contributed to improvements in other dimensions of quality, further examination of the ways in which scribes were used is advisable before widespread adoption in VHA EDs.Copyright © 2024 Elsevier Inc. All rights reserved.

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