Using AI scribes in emergency rooms can improve patient care

Recording patient details is important but tedious. AI-based documentation saves precious time that ER doctors can spend caring for their patients.

By Talia Gordon Wexler

The emergency room is never peaceful. Patients fill the hospital’s waiting room and hallways, waiting to be seen by the physicians who are on their third 12-hour night shift in a row. Physicians, throughout their shift, juggle various cases: the child crying with a broken arm, an older man struggling to breathe, and the pregnant woman in labor. Between patient visits, physicians return to their computers to write down every detail for patient records, billing, and legal reasons. This process is called documentation.

Documentation is recording details about the patient, including symptoms, medications, assessments, treatments, and is used to inform patient care, billing, and communication with other healthcare providers. But documentation takes up a lot of a physician’s time, as it requires accuracy and detailed notes. When physicians focus on recording patients’ intake instead of the interaction itself, they reduce the quality of care and the overall flow of information in emergency departments.

But, beneath the chaos and noise of the emergency room, a subtle transformation is underway. Artificial intelligence or AI “scribes” have entered the lives of emergency medicine physicians. Jacob Morey, a practicing emergency medicine physician at Mayo Clinic, said using AI is “freeing” because he can direct his focus on patients rather than his notes. Eliminating the need to multitask while speaking with a patient takes the burden off doctors and makes patients feel more cared for.

Emergency room departments should adopt artificial intelligence scribes to ease administrative burdens, improve documentation quality, and restore human connection in medicine. Physicians who are educated and held responsible for monitoring AI scribes can achieve these enhancements, benefiting both their own lives and those of their patients.

Until now, emergency room departments have relied on the physician, the use of a human scribe, or even a virtual scribe, someone on FaceTime, to complete this specific and critical documentation. While human scribes can be useful for physician efficiency, many emergency departments cannot afford the additional staff and resources required for the complex training they must undergo.

Currently, companies like Abridge, Ambience Healthcare, and DeepScribe are designing systems that can be integrated into commonly used electronic health records such as Epic and athenahealth. These software programs can record and recognize a doctor-patient interaction and immediately transfer it into the electronic health record in different formats and templates that work for the physician.

The emerging AI usage is essential right now, as emergency departments in the United States are facing many challenges, such as an increase in patient volume, which has originated from the emergency room being the lowest-cost option of care and the shortage of primary care physicians.

The increase in patient volume has dramatically impacted the time and quality of each physician visit. Emergency medicine physicians recorded spending only a quarter of their shift face-to-face with patients, whereas the other 75 percent was spent on documentation or other desk-related tasks. AI scribes combat this current barrier.

“I don’t have to write stuff down when I am in the room; it saves all the details of that conversation,” said Morey, who was the corresponding author on a new report presented at the American College of Emergency Medicine conference this past September, which will be published in the journal Annals of Emergency Medicine in early April, comparing human scribes and AI scribes.

Recent developments in AI scribes have attracted attention in the clinical and research sectors. JMIR Medical Informatics, an academic journal that focuses on clinical informatics and digitization of healthcare, has a new section dedicated to AI documentation. Based on existing research, physicians feel more present in clinical interactions with patients, benefiting both the provider and the patient’s experience.

Beyond improving bedside connection, AI scribes are improving efficiency within the ER. With the rise of AI comes the learning and understanding of its capabilities. When used correctly and responsibly, AI scribes can enhance physician efficiency in terms of non-clinical tasks such as documentation, but also clinical objectives such as the detection of disease and diagnosis.

A study published in the Journal of the American College of Emergency Physicians (JACEP) last April explains key terminology and the application of AI within emergency medicine. The paper’s goal is to highlight the fascinating tools while recognizing the importance of knowing how to use the technology accurately. Examples such as Viz.ai and Sepsis Watch, AI tools for detecting sepsis and other complications, demonstrate the potential of AI to guide physicians toward more accurate, faster medical diagnoses.  

In terms of physician efficiency, the paper describes the role AI scribes can play in abstracting patient history and symptoms during intake, making documentation less time-consuming. One way the scribes ease the process is with the installation of pre-templated notes, making documentation more organized and fluent.

“It does produce higher quality documentation with less burden from me,” said Dr. Matt Goebel, a physician and co-author on the JACEP study.

The Permanente Medical Group, a physician-led medical organization, published a paper in NEJM Catalyst that analyzed the role of AI after implementing it over a year ago. AI scribes saved physicians an estimated 15,791 hours of documentation, time that could be better spent on patient-physician interactions. Furthermore, the findings, which build on the group’s 10-week pilot study, offer evidence that the technology can alleviate non-clinical tasks and can redirect physicians’ energy to medical decision-making and human connection, the parts of medicine that excite and sustain them.

When efficiency increases, so does balance, a crucial shift for emergency physicians who are often pushed to their limits mentally and physically.

Since the COVID pandemic, there has been a rise in emergency medicine physician burnout. Physician burnout disrupts the ability to deliver high-quality and efficient care because of the turnover of staff, and the economic challenges hospitals face in paying multiple doctors.

An article published in JAMA Network this October examined physician burnout rates when AI scribes are utilized. Through pre- and post-intervention surveys, it was seen that burnout rates decreased by over 20%. In addition, the surveys collected that patients’ interaction improved through an increase in undivided attention and patient understanding of future care.

With all AI tools, there are clear limitations and risks that come with the usage and implementation of this newer technology. One of the concerns that Goebel mentioned was the hospital’s arrangement. Not all emergency departments have individual rooms, which causes patients to be separated by just curtains. The commotion of surrounding patients and healthcare workers can greatly affect the accuracy and accessibility of AI scribes. The overlapping of voices can confuse the technology and ultimately ruin the documentation.

Furthermore, Goebel and Morey both emphasized the need for physicians not to solely rely on AI scribes for documentation purposes. For emergency room doctors, medical decision-making is the most crucial part of documentation as it recommends the best course of action for the patient. Companies are currently rolling out AI scribes not just to transcribe and organize a physician’s notes but also to suggest decision-making. Physicians must continue to review AI-generated decisions since the technology can produce frequent errors. As AI continues to make its way into medicine, it is important not to fall into the pattern of just using the technology without overseeing the recommendations it provides.

But this can be addressed by increased usage in hospital settings to improve algorithm errors and bias. Companies are currently working on creating a diverse training data and enforcing bias detection within the systems to allow for greater accuracy. This is just the beginning of AI usage in emergency rooms; AI scribes will only grow in terms of abilities and accessibility.

“What I am most excited for is when they are more integrated into the electronic medical record like a digital assistant and can immediately order medication after I assess a patient,” said Goebel.

Because AI scribes help emergency departments reduce physician burnout, improve efficiency, and enhance patient care, they should be embraced. Restoring human connection through undivided physician attention improves relationships between patients and providers. AI scribes represent the future of healthcare through compassionate patient care and changes in non-clinical workflows.