Ambient Artificial Intelligence Versus Human Scribes in the Emergency Department

To compare the use of ambient artificial intelligence (AI) versus human scribes in the emergency department in terms of note quality and time spent in the electronic health record.

A quality improvement pilot was performed with 5 early adopters from December 2024 to January 2025. Physicians were assigned to a human or AI scribe. Two physicians, blinded to the chart's origin, scored notes using the Physician Documentation Quality Instrument (PDQI-9). We accessed our electronic health record for time metrics and note contributions and compared PDQI-9 scores, time metrics, and note contribution between groups.

There were 710 visits, 284 with human scribes (123 adult and 161 pediatric) and 426 with AI-assisted charting (271 adult, 155 pediatric). PDQI-9 scores were similar for adults, but AI scribes scored lower for pediatric patients (41.36 versus 42.25, adjusted risk ratio [aRR] = -1.89 [95% confidence interval (CI) -3.58 to -0.20]). More time in the electronic health record notes section per patient was spent when using AI scribes (adult: 4.3 versus 1.8 minutes, aRR = 2.38 [95% CI 1.85 to 3.05]; pediatric: 3.5 versus 1.6 minutes, aRR = 2.21 [95% CI 1.94 to 2.51]). Note length was similar but physicians contributed significantly more characters per note when using AI (adult: 60.1% versus 30.8%, adjusted mean differences = 32.9 [95% CI 20.8 to 45.0]; pediatric: 62.3% versus 27.1%, adjusted mean differences = 35.2 [95% CI 29.7 to 40.7]).

In comparison to human scribes, AI scribes were associated with more time spent in the electronic health record notes section, more physician note contribution, and similar to lower quality notes.