Scribes in the ER

In a relatively short period of time, the nature of outpatient health care delivery has experienced an interesting revolution, as the idea of a scribe has spread like an epidemic.  A couple of years ago, being a medical scribe was the fastest growing job in America, and that may still be the case.  A scribe basically follows a clinician around and records the doctors activities and words, facilitating creation of medical and billing records.  They supposedly allow for much greater productivity and better real-time documentation.  The phenomenon has spread around the world.  A study in the British Medical Journal evaluates the impact of scribes in the emergency room setting in Australia.   (BMJ Study)   The study took place in five ERs and randomly assigned doctors to scribed and non-scribed shifts and compared physician productivity, any harms from use of scribes and performed a cost-benefit analysis.

The scribed shifts showed an increase in patients seen per hour from 1.13 to 1.3 or a 16% increase.  For primary consultations, the increase was from .84 to 1.04 or a 26% rise.  There was no significant change in time from the patient’s door to seeing a doctor.  And the median length of stay in the ER declined from 192 minutes to 173, about a 10% reduction.  No significant patient harms were reported.  In terms of the cost/benefit analysis for the hospitals running the ERs, assuming that patient revenue was unchanged, there was a saving of about $25 per hour in physician cost.  If a doctor worked 40 hours a week, that would be a $1000 per week savings, or over $5000 a year.  In the US, the savings might be greater since we pay doctors more.  But the system may end up spending more since it is likely that the use of scribes in the US results in higher revenue from “more complete” coding and procedure capture.  But it is an interesting glimpse at a relatively unheralded but dramatic change in health care delivery.