Linda L. Brown

Background: Health care organizations have started to implement artificial intelligence–powered ambient scribe technology in clinical documentation workflows. Early outpatient studies have shown mixed results. Few studies have evaluated ambient scribes in the emergency department (ED). Due to differences in setting and patient acuity between the ED and ambulatory clinics, there remains a pressing need to research this technology in the ED. Objective: This study aimed to evaluate emergency physicians’ (EPs) satisfaction, perceived documentation efficiency, after-shift documentation time, and trust in ambient scribe–generated notes compared with in-person scribes or independent documentation, and to identify ED-specific challenges. Methods: A cross-sectional survey was conducted among 16 board-certified adult and pediatric EPs who were granted access to the ambient scribe technology across 4 EDs. EPs used the ambient scribe for several months before completing a survey with multiple-choice and free-text responses. We performed a mixed methods analysis by summarizing quantitative data through descriptive statistics and performing a practical thematic analysis on free-text responses. Results: Of the 16 EPs, 14 (87.5%) completed the survey. Among respondents, 9 (64.3%; 95% CI 38.7%-83.7%) reported being satisfied or very satisfied with the ambient scribe, while 3 (21.4%; 95% CI 7.6%-47.6%) expressed dissatisfaction. When given the option, 7 (50%; 95% CI 26.8%-73.2%) respondents preferred the ambient scribe, 4 (28.5%; 95% CI 11.7%-54.6%) preferred in-person scribes, and none (95% CI 0%-20.6%) preferred independent documentation. Among previous users of in-person scribes, 50% (4/8; 95% CI 21.5%-78.5%) favored the ambient scribe. The ambient scribe was reported to improve documentation efficiency (10/14, 71.4%; 95% CI 45.4%-88.3%) and reduce after-shift documentation time (9/14, 64.3%; 95% CI 38.7%-83.7%). However, only 42.9% (6/14; 95% CI 22.3%-69.2%) of respondents trusted the accuracy of ambient scribe–generated notes, compared with 75% (6/8; 95% CI 40.9%-92.9%) who trusted in-person scribes. Few respondents found the ambient scribe helpful for physical examinations (3/13, 23.1%; 95% CI 8.2%-50.3%) or medical decision-making documentation (5/14, 35.7%; 95% CI 16.3%-61.2%). A thematic analysis identified 5 themes: challenges due to the workplace environment, challenges due to the patient population, workflow improvement, workflow harm, and narrow usefulness. Conclusions: This mixed methods pilot study is among the first to evaluate ambient scribe technology in the ED. Our results add ED-specific insights to literature focused on the outpatient setting. Our findings reveal the potential for enhancing documentation efficiency and reducing administrative burden while highlighting setting-specific challenges. While most EPs preferred artificial intelligence–assisted documentation over independent charting, confidence in documentation accuracy and functionality remains limited compared with human scribes and varies by note component. As the demand for efficiency in emergency medicine continues to grow, scalable solutions such as ambient scribes could play a pivotal role if functionality, reliability, and physician trust can be further optimized.

BACKGROUND Health care organizations have started to implement artificial intelligence–powered ambient scribe technology in clinical documentation workflows. Early outpatient studies have shown mixed results. Few studies have evaluated ambient scribes in the emergency department (ED). Due to differences in setting and patient acuity between the ED and ambulatory clinics, there remains a pressing need to research this technology in the ED. OBJECTIVE This study aimed to evaluate emergency physicians’ (EPs) satisfaction, perceived documentation efficiency, after-shift documentation time, and trust in ambient scribe–generated notes compared with in-person scribes or independent documentation, and to identify ED-specific challenges. METHODS A cross-sectional survey was conducted among 16 board-certified adult and pediatric EPs who were granted access to the ambient scribe technology across 4 EDs. EPs used the ambient scribe for several months before completing a survey with multiple-choice and free-text responses. We performed a mixed methods analysis by summarizing quantitative data through descriptive statistics and performing a practical thematic analysis on free-text responses. RESULTS Of the 16 EPs, 14 (87.5%) completed the survey. Among respondents, 9 (64.3%; 95% CI 38.7%-83.7%) reported being satisfied or very satisfied with the ambient scribe, while 3 (21.4%; 95% CI 7.6%-47.6%) expressed dissatisfaction. When given the option, 7 (50%; 95% CI 26.8%-73.2%) respondents preferred the ambient scribe, 4 (28.5%; 95% CI 11.7%-54.6%) preferred in-person scribes, and none (95% CI 0%-20.6%) preferred independent documentation. Among previous users of in-person scribes, 50% (4/8; 95% CI 21.5%-78.5%) favored the ambient scribe. The ambient scribe was reported to improve documentation efficiency (10/14, 71.4%; 95% CI 45.4%-88.3%) and reduce after-shift documentation time (9/14, 64.3%; 95% CI 38.7%-83.7%). However, only 42.9% (6/14; 95% CI 22.3%-69.2%) of respondents trusted the accuracy of ambient scribe–generated notes, compared with 75% (6/8; 95% CI 40.9%-92.9%) who trusted in-person scribes. Few respondents found the ambient scribe helpful for physical examinations (3/13, 23.1%; 95% CI 8.2%-50.3%) or medical decision-making documentation (5/14, 35.7%; 95% CI 16.3%-61.2%). A thematic analysis identified 5 themes: challenges due to the workplace environment, challenges due to the patient population, workflow improvement, workflow harm, and narrow usefulness. CONCLUSIONS This mixed methods pilot study is among the first to evaluate ambient scribe technology in the ED. Our results add ED-specific insights to literature focused on the outpatient setting. Our findings reveal the potential for enhancing documentation efficiency and reducing administrative burden while highlighting setting-specific challenges. While most EPs preferred artificial intelligence–assisted documentation over independent charting, confidence in documentation accuracy and functionality remains limited compared with human scribes and varies by note component. As the demand for efficiency in emergency medicine continues to grow, scalable solutions such as ambient scribes could play a pivotal role if functionality, reliability, and physician trust can be further optimized.

Objective: SimBox simulations allow for high-frequency open-access health care education, overcoming cost and resource barriers. Prehospital paramedics and emergency medical technician (EMT) care for children infrequently. In this study, prehospital providers evaluated pediatric SimBox simulations. Methods: This was a cross-sectional study of EMS professionals participating in a series of simulations conducted in a larger project assessing improvement of the quality of pediatric care in the prehospital setting. Participants were teams of two, which comprised a paramedic/paramedic, paramedic/EMT, or 2 EMTs. The simulations used facilitator resources, debriefing prompts, video depictions of patients and vital signs, and a low-fidelity manikin. Pediatric emergency care coordinators, EMS training officers, and/or emergency physicians facilitated simulations of seizure, sepsis with respiratory failure, and child abuse, followed by debriefings. Participants completed an online survey after the simulation and rated it in 4 domains: prebriefing, scenario content, debriefing, and overall. Ratings were trifold: “strongly agree,” “somewhat agree,” or “do not agree.” Data were analyzed by case type, participant type, location, participant reaction to simulation elements, and the debriefing. Net Promoter Scores were calculated to assess participant endorsement of SimBox. Results: There were 121 participants: 103 (87%) were paramedics, and 18 (13%) were EMTs. Participant agreement of simulation benefit for clinical practice was high, for example, “I am more confident in my ability to prioritize care and interventions” (98.4% strongly or somewhat agree), and 99.2% of participants agreed the postsimulation debriefing with facilitators “provided opportunities to self-reflect on my performance during simulation.” Overall, 97.5% strongly or somewhat agreed that the simulations “improved my comfort in pediatric acute care.” Net Promoter Score showed 65.3% were promoters of and 24% were passive about SimBox. Conclusion: SimBox simulations are associated with improved self-efficacy of prehospital care providers for care of acutely ill or injured children. The majority promotes SimBox as a learning tool.