title: Scribes in an Australian private emergency department: A description of physician productivity.
abstract: OBJECTIVE
  The study aims to determine if trained scribes in an Australian ED can assist emergency physicians (EPs) to work with increased productivity.
  
  
  METHODS
  This was a pilot, prospective, observational study conducted at a private ED in Melbourne. A scribe is a trained assistant who works with an EP and performs non-clinical tasks that reduce the time spent providing clinical care for patients. Shifts with and without a scribe were compared. The primary outcomes were patients per hour per doctor and billings per patient. Additional analyses included total patient time in ED; individual doctor productivity; time to see a doctor; time on ambulance bypass; and complaints/issues identified with scribes.
  
  
  RESULTS
  There was an overall increase in doctor consultations per hour of 0.32 patients (95% confidence interval (CI) 0.17, 0.47). This varied between doctors from an increase in patients per hour of 0.16 (95% CI -0.09, 0.40) to 0.65 (95% CI 0.41, 0.89). Billings per patient were increased (AUD15.24; 95% CI -AUD18.51, AUD48.99), but the increase was not statistically significant; time to see a doctor reduced by 22 min (95% CI 11, 33); bypass episodes reduced by 66 min per shift (95% CI 11, 122), total patient ED stay remained constant.
  
  
  CONCLUSIONS
  In this pilot study, scribe usage was feasible, and overall improvements in consultations per hour were seen. Overall income improved by AUD104.86 (95% CI AUD38.52, AUD171.21) per scribed hour. Further study is recommended to determine if results are sustained or improved over a longer period.
authors.affiliation: Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Walker
authors.forename: Michael
authors.initials: M
authors.lastname: Ben-Meir
authors.forename: Phebe
authors.initials: P
authors.lastname: O'Mullane
authors.forename: David
authors.initials: D
authors.lastname: Phillips
authors.forename: Margaret
authors.initials: M
authors.lastname: Staples
mesh_terms: D000328:Adult; D001315:Australia; D017598:Efficiency, Organizational; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010823:Physician Assistants; D010865:Pilot Projects; D011446:Prospective Studies
keywords: doctor's assistant; efficiency; emergency medicine; organisational; performance indicator; scribe