Scribes in an Australian private emergency department: A description of physician productivity

• Published in: Emergency medicine Australasia 2014-12, Vol.26 (6), p.543-548
• Main Authors: Walker, Katherine, Ben-Meir, Michael, O'Mullane, Phebe, Phillips, David, Staples, Margaret
• Format: Article
• Language: English
• Subjects: Adult; Australia; doctor's assistant; efficiency; Efficiency, Organizational; Emergency Medicine; Emergency Service, Hospital - organization & administration; Feasibility Studies; Female; Humans; Male; Middle Aged; organisational; performance indicator; Physician Assistants; Pilot Projects; Prospective Studies; scribe
• ISSN: 1742-6731; 1742-6723
• DOI: 10.1111/1742-6723.12314

Objective The study aims to determine if trained scribes in an Australian ED can assist emergency physicians (EPs) to work with increased productivity. Methods This was a pilot, prospective, observational study conducted at a private ED in Melbourne. A scribe is a trained assistant who works with an EP and performs non‐clinical tasks that reduce the time spent providing clinical care for patients. Shifts with and without a scribe were compared. The primary outcomes were patients per hour per doctor and billings per patient. Additional analyses included total patient time in ED; individual doctor productivity; time to see a doctor; time on ambulance bypass; and complaints/issues identified with scribes. Results There was an overall increase in doctor consultations per hour of 0.32 patients (95% confidence interval (CI) 0.17, 0.47). This varied between doctors from an increase in patients per hour of 0.16 (95% CI −0.09, 0.40) to 0.65 (95% CI 0.41, 0.89). Billings per patient were increased (AUD15.24; 95% CI −AUD18.51, AUD48.99), but the increase was not statistically significant; time to see a doctor reduced by 22 min (95% CI 11, 33); bypass episodes reduced by 66 min per shift (95% CI 11, 122), total patient ED stay remained constant. Conclusions In this pilot study, scribe usage was feasible, and overall improvements in consultations per hour were seen. Overall income improved by AUD104.86 (95% CI AUD38.52, AUD171.21) per scribed hour. Further study is recommended to determine if results are sustained or improved over a longer period.