The Joint Commission “does not endorse nor prohibit the use of scribes,”
but it does have expectations for their use.
in front of patients and prefer the anonymity of writing down
notes and dictating after the fact.
However, open communication with the scribe offers additional benefits. It opens communication with everyone in the
room, helping residents learn, bringing immediate understanding of the care plan to the nurse, and opening up communication to the most important people in the room—the patient and
the family.
Process
Initially Children’s followed the direction of the physician-owned scribe program contracted to implement the program
and used a standard template with defaulted phrases for the
review of systems and physical exam. It was discovered early on
that the contracted interim scribes were documenting a full review of systems and physical examination for each visit.
A coding manager accompanied the scribes to validate that
this level of service was actually taking place. It was determined
that after the initial admission examination, the providers were
performing focused examinations; that is, reviewing one or two
systems and examining only those parts of the body that result-
ed in admission. The coding manager met with the scribes and
communicated to the providers that only those elements that
were reviewed could be documented to avoid fraudulent claims.
Technology
The computers on wheels the scribes used to create notes in real
time worked well with the exception of battery life. When the
computers were fully charged, batteries lasted about five hours,
which was generally sufficient.
However, scribes shared unit-based computers at first, and
during pediatric surge period (generally November to March)
the computers were in such frequent use that they could not always be fully charged before the scribes needed them. At times
the batteries ran out during rounding, and the scribes had to
either locate a charged computer or plug-in, power-up, and
sign-in at each patient encounter. This was a struggle during the
intense, nonstop rounding process.
