A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes

Area of Science:

• Health Economics
• Emergency Medicine
• Healthcare Management

Background:

• Physician documentation is a significant time consumer in emergency departments.
• Accurate cost assessment of physician documentation is crucial for resource allocation.

Purpose of the Study:

• To determine emergency medicine physician documentation costs using time-driven activity-based costing (TDABC).
• To compare documentation costs with and without the assistance of scribes.

Main Methods:

• A prospective observational cohort study was conducted in a large academic emergency department.
• Physician documentation time was recorded using a tablet-based system during control (no scribe) and intervention (scribe) shifts.
• 64 hours of shadowing by research assistants experienced in ED workflow and physician-scribe interactions were performed.

Main Results:

• Physician documentation time decreased from approximately 3 hours per 8-hour shift without scribes to 1 hour and 45 minutes with scribes.
• Post-shift documentation time reduced from 1 hour to 15 minutes with scribe assistance.
• Estimated physician documentation costs decreased from $644 to $488 per shift with scribe utilization.

Conclusions:

• Scribe utilization appears to be a financially sound decision, saving provider time.
• TDABC methodology confirms scribes offer a cost-effective solution for ED clinical documentation.
• TDABC provides a granular understanding of resource use and enables accurate costing systems.