Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

As Healthcare Delivery Evolves, Scribes Embrace Their Full Potential

7/29/2014 2:28:11 PM | 0 comments

"They haven't gotten rid of you yet?" one of the nurses asked five years ago in my third month as a scribe.

At the time, I was still becoming familiar with what a urine dip was and why someone would order an ultrasound for a patient who was not pregnant. I was too confused to immerse myself in the bustling emergency department (ED) culture where there was not even a place to sit.

To respond to the nurse's comment five years later, "No, they haven't gotten rid of us yet."

We still may not always have enough space, but we proudly type away in the halls. What's more, we're finding new ways to contribute to the delivery of patient-centered care and the success of our departments.

More Than Ever, Culture Matters in Healthcare

Imagine an ED where the best-trained physicians and medical staff in the world collectively lead their teams toward better healthcare delivery. It is a place where language, religion, culture, social status, attitudes, disease, traditions, medicine and science converge like magic. This hardworking ED keeps the community afloat and provides everyone — regardless of income — a safe haven to obtain medical care.

Beneath the chaos, there is a methodical flow to the department, a synergy that depends on its culture as much as its established policies.

As a CEP America scribe trainer who has traveled to hospitals around the country, I try to embody the unique culture at each ED I visit. I learned how to say, "Thank you, ma'am," and "I appreciate y'all," in hardworking rural northwest Arkansas. I also learned to take a history with a Spanish interpreter interpreting for an indigenous language interpreter interpreting for a patient in California's Central Valley (home to the fearless migrant workers who nourish us with fresh produce). I watched an ED with only eleven beds valiantly succeed every day in treating its extremely underserved yet rapidly growing community. I felt the 115-degree heat after leaving shifts in Apple Valley, and also watched teams treat children with gunshot wounds in one of the most dangerous areas of Los Angeles.

While each site was unique, CEP America's foundational values of innovation, leadership, collaboration and integration shone brightly at each. And I found myself reflecting on how scribes could — and should — contribute to that culture.

The Evolving Role of Scribes

Even in the most literal sense, scribing provides a valuable service. We're part of the solution to one of the greatest challenges facing healthcare providers: the need to document efficiently and effectively. Passage of the HITECH Act in 2009 led IT companies to rush ill-conceived software onto the market. Many providers found that when they adopted these systems, their productivity took a nosedive.

Scribes not only helped solve that problem, they also helped to enhance communication across the Acute Care Continuum and reduce medical errors. Most of all, they freed physicians to use all their energy toward patient care.

However, technology is now catching up by providing more user-friendly EMR options. This means that in order to add value, scribes must find new ways to adapt, collaborate and enhance overall ED culture.

In a way, the challenge is welcome. While creating medical records is fundamental to our role, we also have a genuine desire to contribute more directly to our department's success. After all, many of us are health professions students who hope to be standing in our teammates' shoes in a few years time.

How Scribes Can Add Value

In 2011, as the lead scribe at the third-largest ED in Los Angeles, I started thinking of ways scribes could contribute to the culture of excellence (which ranked in the top 5 percent nationally for quality). I noticed that by tracking patient care via EMR, we were creating something of a physical and emotional disconnect with the patients lying in the beds. So we started a patient advocacy program that requires each scribe to provide unsolicited attention to four of their most vulnerable patients per shift — usually by updating them on waiting times for procedures or telling them about next step in the plan of care. These small conversations led to smiles — something that became imprinted on both the patients' and scribes' hearts.

Four supportive encounters may not sound like much. But at a site with six scribe shifts per day, the program touches 8,000 of our most needy patients per year —which may prevent thousands of patient and family complaints.

Using Scribes to Their Full Potential

Instead of contributing to the department culture purely through data wrangling, it's time for scribes to move toward greater social responsibility and action. It's time for us to work within our scope of practice to increase patient satisfaction, improve throughput and enhance the quality of care delivered.

In my role, I've been honored to meet many phenomenal medical directors and scribe managers who have changed department policy to integrate scribes into the care team. A positive first step might be to include scribes in department meetings to provide a sense of inclusiveness and plenty of action items to work on.

When scribes contribute to patient-centered care and data-driven results, they also contribute to the overall ED culture by creating a collective sense of achievement among team members. Greater involvement also cultivates scribes' empathetic and analytical pathways, which will shine in our own practices when we hopefully return one day as licensed providers.

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