Abstract 1: Impact Of Scribes On EM Productivity + Throughput

Impact Of Scribes On Emergency Medicine Doctors’ Productivity And Patient Throughput: Multicentre Randomised Trial Walker, K., et al, BMJ 364:l121, January 30, 2019

SUMMARY:

• Scribes have multiple roles in an emergency department including documenting the visit, completing the chart (ROS), interacting with the EMR, calling consultants, arranging follow up, getting results of labs and tests, and a variety of other forms of clerical help
• Some studies have shown gains in productivity when using scribes, while others have shown them to be net neutral, but all these are limited by sample size and design flaws
• This study is a prospective, multicenter, non-blinded RCT at 5 EDs in Australia looking primarily at the impact on productivity and throughput
• Emergency physicians who provided written informed consent had a scribe randomly allocated to their routine shifts, and they compared their productivity between contemporaneous scribed and non-scribed shifts
• Among 88 physicians they found a 16% relative gain in productivity (1.13 patients per hour vs. 1.38 patients per hour) and a 19 minute average reduction in length of stay on scribe shifts – also did a cost benefit analysis and found scribes to have a favorable financial position
• They found the least throughput gains among fast track patients, likely correlating with the lower need for consults, tests and clerical work in this cohort
• Their findings still need to be validated in other countries, other practice environments and other healthcare systems

FULL ARTICLE: https://www.bmj.com/content/364/bmj.l121.long

EDITOR’S COMMENTARY: In this well conducted RCT evaluating the use of scribes in the ED, the authors found gains in productivity and throughput as well as generating a favorable financial position. I think in the right setting scribes have tremendous value, and in future work I would like to see the impact on time spent documenting and interacting with the EMR, which are both major sources of burnout in our profession.

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