A multicentre randomised trial in Australia demonstrated that the use of scribes improved emergency physicians’ productivity, particularly during primary consultations, and decreased patients’ emergency department length of stay. In addition, financial analysis based on gains in productivity and throughput supports implementation of scribes.
A medical scribe helps the physician by doing clerical tasks such as documenting consultations, arranging tests and appointments, booking beds, and completing electronic medical record tasks. The aim of the role is for scribes to do clerical tasks otherwise done by the physician, enabling the physician to manage more patients in the same amount of time.
Scribes in emergency medicine have been reported to increase productivity in some studies and provide no gains in others. Data also show that scribes are well tolerated by patients, and most physicians find working with scribes beneficial. However, no multicentre randomised studies have been done, and patient safety incidents (adverse events or near misses) associated with scribes have not been evaluated. Greater understanding of the effect of scribes on physicians’ productivity will help to inform decisions about whether to start scribe programmes.
For this randomised clinical trial, five emergency departments (EDs) in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian EDs: public (urban, tertiary, regional referral, paediatric) and private, not for profit. Study participants included 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site.
Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. Main outcome measures were physicians’ productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); and physicians’ productivity in emergency department regions. Self-reported harms of scribes were analysed, and a cost-benefit analysis was done.