The Use of Medical Scribes

Have you or a family member had to go to the emergency room lately? Thank goodness we have great ER’s but sometimes it can seem like a zoo and the wait can be terrible. I worked in the emergency room for twelve years, I know!

Robert Preidt of the HealthDay Reporter wrote an interesting article concerning how medical scribes could help to improve the ER Care.

By using medical scribes in an emergency department it would result in a smarter way to increase the number of patients that could be seen by doctors and also reduce the time that patients have to spend in the ER.

The duties of the medical scribe is administrative tasks, such as documenting visits while a doctor is evaluating the patient, printing out the paperwork and then arranging the tests and appointments for the patient.  It seems this would better document the doctor-to-patient face-to-face time with a complete record of more accurate detail.

There has been little research into the benefits of using them in ER rooms or how their use might affect patient safety, but most doctors find scribes helpful.  In five Australian emergency departments a study completed by researchers examined the productivity of doctors both work with and without scribes.  The scribes were medical or pre-med students trained before the study and randomly assigned to a doctors specific routine shift.

Data was collected from 589 scribe-assisted shifts of 5,098 and unassisted shifts of 3,296.  They found the use of scribes increased the number of patients per hour for each doctor by 15.9% overall and 25.6% for primary consultation.

The wait time to see a doctor did not change but they did spend 19 minutes less in the ED when a scribe was present.  This seemed to have the greatest impact when scribes were with senior doctors at triage, where the cases are assessed and prioritized, tests ordered and some treatments begun before the patient sees a doctor in the main ED.

There were no significant safety issues when the scribes were used, and only resulted in one in 300 scribed consultations that involved a patient safety incident.  Most were incorrect patient identification and ordering of tests, of which half of the incidents the scribe helped prevent a medical error, according to the study that was published in the BMJ.

The final conclusion was that using scribes could save a hospital $26.15 per scribed hour if the cost of training was covered by the hospital, and $31.15 per scribe hour if the scribe paid for the training.  Dr. Katie Walker, director of emergency medicine research at Cabrini Hospital in Melbourne, Australia was the lead in the study.

Walker and colleagues concluded that with the strong preference of physicians working with a scribe, no effect on the patient experience, minimal risk, productivity and throughput gains outlined, the ER department and hospital administrators should strongly consider the potential local utility of scribes in their workforce and in their financial planning.

Dr Fredda Branyon