Ambient Artificial Intelligence Scribe Adoption and Documentation Time in the Emergency Department

To describe real-world adoption of an ambient artificial intelligence (AI) scribe in the emergency department (ED) and compare documentation time and note characteristics between ambient and standard encounters using electronic health record audit logs.

We performed a retrospective observational study of adult ED encounters at a tertiary academic medical center. Attending physicians could optionally use an ambient AI scribe to generate notes from patient-clinician conversations. We included single-attending encounters in core ED zones and excluded visits with human scribes. Electronic health record audit logs provided documentation of time during and after the shift, total electronic health record time, and note length. We summarized adoption by physician, zone, and acuity and compared medians between ambient and standard encounters.

Among 8,740 eligible encounters, 976 (11.2%) used ambient AI. Thirty-five of 92 attendings (38%) used the tool, and a small group of high-frequency users accounted for most ambient encounters. Ambient use clustered in telemedicine and vertical-care zones (chair-based ambulatory care) and in lower-acuity patients, as well as those not requiring interpreters. Median on-shift documentation time was 2:45 min for ambient encounters versus 3:50 min for standard encounters (difference -1:05; -28%). Median total electronic health record time was 8:39 min versus 10:21 min (-16%), and ambient notes were shorter overall.

Early ED implementation of ambient AI scribes showed low but highly skewed adoption, with physicians favoring lower acuity, noninterpreted encounters. When used, ambient AI was associated with shorter on-shift documentation time, total electronic health record time, and note length.