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. 

6 Ways Scribes Can Help With Service Excellence

3/7/2014 8:15:41 PM | 0 comments

Have you ever gone to a restaurant where the service was lackluster and you were charged for every little thing — even 10 cents for the doggie bag? You waited 30 minutes for a server to acknowledge you had been seated. It took an hour for the food to come out, and then it was cold. The server forgot a portion of your order and took another 20 minutes to bring it out. And at the end of the meal, you were handed a check for $300, when you feel like it should have been $20 based on your experience.

As a healthcare consumer, you may have had a similar experience when seeing a physician. A visit to the emergency department meant five hours in the waiting room, then another hour in the examination room before you saw the doctor (who just sat behind a computer and barely came to the bedside). Then you waited another two hours for labs to come back — all while not really knowing how long the wait would be or when the doctor would be back to see you. And when the encounter was over, you received a lovely bill for $3,000.

While it's always been important to keep patients at the center of care, hospitals can no longer afford poor (or even mediocre) service. As mandated by the Affordable Care Act, Medicare now factors HCAHPS into the incentive payments distributed under its Hospital Value-Based Purchasing (HVBP) program. And just as Yelp made it difficult for sub-par restaurants to fly under the radar, the Medicare Hospital Compare website allows consumers to compare facilities' HCAHPS scores and performance metrics — and spend their healthcare dollars accordingly.

So with these new requirements and incentives, how do hospitals make the patient experience top-notch and the patient feel like the $3,000 bill they received was a bargain for the service and experience they had? One low-cost (and often overlooked) solution is to incorporate medical scribes into the care team.

Contrary to popular belief, scribes do much more than assist providers with documentation. They also help hospitals to fulfill several key criteria under the HVBP program's "Patient Experience of Care" domain, including Nurse Communication, Doctor Communication, Hospital Staff Responsiveness and Overall Hospital Rating.

Here are 6 ways scribes can be a part of making the patient hospital experience top-notch:

1. Patient Satisfiers. Scribes can bring blankets, water, stickers and other comfort measures to the patient and family members (so long as these are approved by a nurse/physician). They can provide status updates to the patient, i.e., "The physician will be back to see you in 20 minutes." If no one has been in the room for over an hour, the scribe can stop by to see if there is anything the patient needs and relay that information to the rest of the care team.

2. Messengers. Providers are constantly interrupted by requests from various care team members. The scribe can help the provider stay focused by being a "messenger" and taking down notes from the tech, nurse, etc. The fewer the interruptions, the quicker the care plan can be executed for the patient, and the quicker the care team can get answers.

3. Care Team Support. Scribes handle documentation so that physicians can continue doing what they do best: spending time at the bedside with the patient. Scribes can also assist with things such as printing the discharge instructions and notifying the nurse when the physician is ready to discharge a patient so they can handle the discharge together.

4. Radar Screen. Scribes can keep the physician up to speed on what is going on in the department, especially if the provider gets caught up in a procedure. Scribes can also keep tabs on when lab and x-ray results come back. By keeping track of the "moving parts" in the department, the scribe saves providers from having to personally follow up with the lab track down results and helps them transition more efficiently between tasks.

5. External Memory. The scribe can help the provider remember to ask the patient questions such as, "Do you need a note for work?" This can help save time for the provider and patient at discharge, because when the care team meets the patient, they already have all of the documents prepared. This can mean the difference between a patient leaving right away versus waiting another 20 minutes while a "work note" is created.

6. Stop Watch. The scribe plays a role in keeping the physician on track to revisit patients. If the physician wants to see a patient again in 30 minutes, the scribe can track the time and provide reminders. Scribes can also remind the physician that it has been over an hour since the patient in bed 10 was seen or updated on her care.

With the help of a scribe, these simple, common-sense touches can make all the difference in the patient's experience, and hopefully that $3,000 bill will feel like $300 because they received such great care.



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