Scribes should become a new member of the Emergency Medicine workforce

Dr Katie Walker1, Deanne Robinson
1Cabrini, Malvern, Australia

A medical scribe is a trained clerical assistant (usually a healthcare student) who works at the bedside with an Emergency provider. Scribes document consultations via a computer-on-wheels, find information/people, facilitate tests, book beds, make appointments and print forms/letters. Currently, Emergency Physicians spend 43% of their time on these tasks instead of talking to patients, families or nurses.

A team at Cabrini began investigating whether this role should be introduced to Australia in 2013, at a time when there were only 5 papers in the world literature regarding scribes, all from the USA, where scribes have worked for three decades.

An initial pilot showed 19% productivity gains, evaluating 3 doctors over 6 weeks using one American scribe. An extended pilot with 5 doctors over 6 months and another American scribe showed that some doctors achieved substantial gains, whilst others worked only marginally faster. A feasibility study was undertaken to determine if scribes could be trained in Australia and it demonstrated that scribes could be effectively trained and reported how to do so. The cost of start-up and training scribes was about AUD$9,000 per successful scribe.

The impact of scribes on patients was evaluated using face-to-face interviews and blinded surveys assessing patient satisfaction with ED. Scribes were well tolerated by patients. The impact of scribes on Emergency Physicians was evaluated and 85% really enjoyed working with scribes, whilst 15% preferred to work on their own. A harms evaluation found minimal issues (often scribes prevented errors).

A recently completed multicentre, randomised study at Cabrini and 4 public EDs showed that scribes increase Physician productivity by 16% and reduce patient ED length-of-stay by 20 minutes. Overall, scribes are cost-neutral, increase provider productivity, increase throughput and are highly valued by doctors. We feel that they should join the ED workforce in Australia and further afield.

Katie is an Emergency Physician in Melbourne at Cabrini Hospital and is Director of Emergency Medicine Research. Cabrini is a tertiary not-for-profit (private) hospital close to this conference. She has previously worked in public and private EDs across Victoria, in Wellington NZ and in the South-West of England.
Katie has a strong interest in improving Emergency workforce productivity without compromising on quality and has been researching the role of the medical scribe for the last few years. She also has interests in end-of-life emergency care and in new wearable vital sign devices. She is a founding member of the Australasian College for Emergency Medicine Clinical Trials Network and is a member of the ACEM Geriatric special interest group.