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#123 Medical scribes could help doctors care for more patients


 

15 January 2020

If you started from scratch, you would never design a health system where the most expensive and highly trained decision-maker in the emergency department spends nearly 50 per cent of their time at a computer terminal. Yet this is exactly the situation many emergency doctors find themselves in. 

As an emergency physician, I have spent more than 20 years feeling frustrated by how the design of the hospital system impairs my ability to provide care to patients. Since the introduction of electronic health records, we have become increasingly overloaded with documentation and clerical responsibilities that take us away from our primary duty of caring for our patients. 

While we would all like electronic systems to undertake more tasks and streamline operations automatically, the reality is that current attempts at this are still in their infancy and nowhere near ready to be rolled out. 

At a patient’s bedside, I know what needs to be done for them in terms of diagnosis and treatment. Afterwards, I sit down at a computer and undertake a number of tasks (many of which are secretarial and weren’t required 20 years ago) that take a minimum of 20 minutes per patient. During this time, I often feel distressed, as patients continue to wait while I fill in the necessary paperwork. 

I wanted to test whether employing scribes in emergency departments would reduce the workload for emergency physicians and enable them to safely see more patients, so Cabrini created a team to investigate the role of scribes in emergency medicine.

When we started this work, we were surprised that despite scribes having been used in America for decades, there were no randomised, multi-site studies on their effect on emergency physicians’ productivity. So we embarked on an Australian-first trial, where locally-trained scribes were used in five hospital emergency departments across Victoria – Austin Hospital, Bendigo Hospital, Cabrini Malvern, Dandenong Hospital and Monash Children’s Hospital. This research was recently published in The British Medical Journal.

Scribes are usually health trainees, often studying medicine or another health-related discipline. They are trained to complete clerical data entry associated with a patient’s visit to the emergency department, allowing doctors to concentrate on core medical tasks instead. Throughout the trial, scribes were present during patient consultations and assisted in writing up patient notes, in close consultation with the treating doctor. 

Our research looked at data from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23,838 patients), and compared how productive they were. Results from the trial found scribes increased the efficiency of emergency departments and decreased doctors’ administrative workload. With the assistance of scribes, doctors were able to treat 26 per cent more new patients per shift. 

Our research showed benefits at all of our participating sites, decreasing the total time patients spent in the emergency department by 19 minutes. In addition, 85 per cent of doctors said they preferred to work with scribes. Patients were unaffected by the presence of scribes and the majority were unperturbed about having them in consultations.

There are many benefits to having scribes in hospitals. It allows health trainees to take part in meaningful paid work, while accessing a bedside apprenticeship alongside specialists, which is incredibly valuable to students in the healthcare industry. The use of scribes allows emergency physicians to have a more productive and satisfying experience at work and may help to reduce burnout and fatigue. Most importantly, it reduces the amount of time patients spend in the emergency department. 

Given that, at worst, scribes are cost-neutral with significant associated qualitative benefits, I would say that their introduction is an important step to take for any complex, digitised health service. I hope this research will provide a business case for hospitals to employ scribes in Australia to support emergency physicians by enabling them to safely see more patients. Patients and doctors would both like to see more of each other and scribes enable this to happen.
 

A/Prof Katie Walker
Director, Emergency Medicine Research
Cabrini Malvern
 

Acknowledgment: The author would like to give special thanks to Brian Clare, formerly of eScribe; the Cabrini Foundation; and the Phyllis Connor Memorial Trust, managed by Equity Trustees, for understanding the vision of this project and helping to bring it to life.

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​​​​​​​This article appears in the June 2019 edition of Vicdoc

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