A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes
Objective: To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes. Methods: This was a prospective observation cohort study in a large academic emergency department. Two research assistants with experienc...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-03-01
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| Series: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542454818301218 |
| _version_ | 1819017106870501376 |
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| author | Heather A. Heaton, MD David M. Nestler, MD, MS William J. Barry, ME, MBA Richard A. Helmers, MD Mustafa Y. Sir, PhD Deepi G. Goyal, MD Derek A. Haas, MBA Robert S. Kaplan, PhD Annie T. Sadosty, MD |
| author_facet | Heather A. Heaton, MD David M. Nestler, MD, MS William J. Barry, ME, MBA Richard A. Helmers, MD Mustafa Y. Sir, PhD Deepi G. Goyal, MD Derek A. Haas, MBA Robert S. Kaplan, PhD Annie T. Sadosty, MD |
| author_sort | Heather A. Heaton, MD |
| collection | DOAJ |
| description | Objective: To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes. Methods: This was a prospective observation cohort study in a large academic emergency department. Two research assistants with experience in physician–scribe interactions and ED workflow shadowed attending physicians for a total of 64 hours in the adult emergency department. A tablet-based time recorded was used to obtain estimates for physician documentation time on both control (no scribe) and intervention (scribe) shifts. Results: Control shifts yielded approximately 3 hours of documentation time per 8 hours of clinical time (2 hours during the shift, 1 hour following the shift). When paired with a scribe, attending physician documentation decreased to 1 hour and 45 minutes during a shift and 15 minutes of postshift documentation. The physician cost estimate for documentation without and with a scribe is 644 and 488 dollars, respectively. Conclusions: When one looks at the time saved by the provider, scribes appear to be a financially sound decision. TDABC methodology demonstrated that scribes afford a cost-effective solution to ED clinical documentation and serves as a tool to develop an accurate costing system, based on actual resources and processes, and allowed for understanding of resource use at a more granular level. |
| first_indexed | 2024-12-21T02:58:15Z |
| format | Article |
| id | doaj.art-be20822822b1447f8f4e025867c0e7b3 |
| institution | Directory Open Access Journal |
| issn | 2542-4548 |
| language | English |
| last_indexed | 2024-12-21T02:58:15Z |
| publishDate | 2019-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| spelling | doaj.art-be20822822b1447f8f4e025867c0e7b32022-12-21T19:18:16ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482019-03-01313034A Time-Driven Activity-Based Costing Analysis of Emergency Department ScribesHeather A. Heaton, MD0David M. Nestler, MD, MS1William J. Barry, ME, MBA2Richard A. Helmers, MD3Mustafa Y. Sir, PhD4Deepi G. Goyal, MD5Derek A. Haas, MBA6Robert S. Kaplan, PhD7Annie T. Sadosty, MD8Department of Emergency Medicine, Mayo Clinic, Rochester, MN; Correspondence: Address to Heather A. Heaton, MD, Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55906.Department of Emergency Medicine, Mayo Clinic, Rochester, MNManagement Engineering and Internal Consulting, Mayo Clinic, Rochester, MNDepartment of Critical Care Medicine, Mayo Clinic, Phoenix, AZCenter for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNDepartment of Emergency Medicine, Mayo Clinic, Rochester, MNHarvard Business School, Boston, MA; Avant-garde Health, Boston, MAHarvard Business School, Boston, MADepartment of Emergency Medicine, Mayo Clinic, Rochester, MNObjective: To apply time-driven activity-based costing (TDABC) methodology to determine emergency medicine physician documentation costs with and without scribes. Methods: This was a prospective observation cohort study in a large academic emergency department. Two research assistants with experience in physician–scribe interactions and ED workflow shadowed attending physicians for a total of 64 hours in the adult emergency department. A tablet-based time recorded was used to obtain estimates for physician documentation time on both control (no scribe) and intervention (scribe) shifts. Results: Control shifts yielded approximately 3 hours of documentation time per 8 hours of clinical time (2 hours during the shift, 1 hour following the shift). When paired with a scribe, attending physician documentation decreased to 1 hour and 45 minutes during a shift and 15 minutes of postshift documentation. The physician cost estimate for documentation without and with a scribe is 644 and 488 dollars, respectively. Conclusions: When one looks at the time saved by the provider, scribes appear to be a financially sound decision. TDABC methodology demonstrated that scribes afford a cost-effective solution to ED clinical documentation and serves as a tool to develop an accurate costing system, based on actual resources and processes, and allowed for understanding of resource use at a more granular level.http://www.sciencedirect.com/science/article/pii/S2542454818301218 |
| spellingShingle | Heather A. Heaton, MD David M. Nestler, MD, MS William J. Barry, ME, MBA Richard A. Helmers, MD Mustafa Y. Sir, PhD Deepi G. Goyal, MD Derek A. Haas, MBA Robert S. Kaplan, PhD Annie T. Sadosty, MD A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| title | A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes |
| title_full | A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes |
| title_fullStr | A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes |
| title_full_unstemmed | A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes |
| title_short | A Time-Driven Activity-Based Costing Analysis of Emergency Department Scribes |
| title_sort | time driven activity based costing analysis of emergency department scribes |
| url | http://www.sciencedirect.com/science/article/pii/S2542454818301218 |
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