title: Medical scribes in emergency medicine produce financially significant productivity gains for some, but not all emergency physicians.
abstract: OBJECTIVE
  The present study aims to determine if a scribe in an Australian ED can assist emergency physicians to work with increased productivity and to investigate when and where to allocate a scribe and to whom.
  
  
  METHODS
  This was a prospective observational single-centre study conducted at a private ED in Melbourne. It evaluated one American scribe and five doctors over 6 months. A scribe is a trained assistant who performs non-clinical tasks usually performed by the doctor. The primary outcomes were patients/hour/doctor and billings/patient. Additional analyses included individual doctor productivity, productivity by ED region, shift time, day of the week and physician learning curves. Door-to-doctor time, time spent on ambulance bypass and door-to-discharge time were examined, also complaints or issues with the scribe.
  
  
  RESULTS
  There was an overall increase in doctor consultations of 0.11 (95%CI 0.07-0.15) primary consultations per hour (13%). There was variation seen between individual doctors (lowest increase 0.06 [6%] to highest increase 0.12 [15%]). Billings per patients, door-to-doctor, door-to-discharge and ambulance bypass times remained the same. There was no advantage to allocating a scribe to a specific time of day, day of week or region of the ED. There was no learning period found.
  
  
  CONCLUSIONS
  In the present study, scribe usage was associated with overall improvements in primary consultations per hour of 13% per scribed hour, and this varied depending on the physician. There is an economic argument for allocating scribes to some emergency physicians on days, evenings and weekends, not to trainees.
authors.affiliation: Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Walker
authors.affiliation: Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ben-Meir
authors.affiliation: Business Intelligence Unit, Cabrini Hospital, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Phillips
authors.affiliation: Cabrini Institute, Melbourne, Victoria, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Staples
mesh_terms: D000328:Adult; D000368:Aged; D017598:Efficiency, Organizational; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008497:Medical Record Administrators / Q000191:economics*; D008875:Middle Aged; D011446:Prospective Studies; D014739:Victoria; D000078329:Workforce
keywords: doctor's assistant; emergency medicine; medical scribe; productivity; scribe