title: An economic evaluation of the costs of training a medical scribe to work in Emergency Medicine.
abstract: OBJECTIVE
  To undertake a cost analysis of training medical scribes in an ED.
  
  
  METHODS
  This was a pilot, observational, single-centre study at Cabrini ED, Melbourne, Australia, studying the costs of initiating a scribe programme from the perspective of the hospital and Australian Health sector. Recruitment and training occurred between August 2015 and February 2016 and comprised of a prework course (1 month), prework training sessions and clinical training shifts for scribe trainees (2-4 months, one shift per week) who were trained by emergency physicians. Costs of start-up, recruitment, administration, preclinical training, clinical training shifts and productivity changes for trainers were calculated.
  
  
  RESULTS
  10 trainees were recruited to the prework course, 9 finished, 6 were offered clinical training after simulation assessment, 5 achieved competency. Scribes required clinical training ranging from 68 to 118 hours to become competent after initial classroom training. Medical students (2) required 7 shifts to become competent, premedical students (3) 8-16 shifts, while a trainee from an alternative background did not achieve competency. Based on a scribe salary of US$15.91/hour (including 25% on-costs) plus shift loadings, costs were: recruitment and start-up US$3111, education US$1257, administration US$866 and clinical shift costs US$1137 (overall cost US$6317 per competent scribe). Physicians who trained the clinical trainee scribes during shifts did not lose productivity.
  
  
  CONCLUSIONS
  Training scribes outside the USA is feasible using an on-line training course and local physicians. It makes economic sense to hire individuals who can work over a long period of time to recoup training costs.
  
  
  BACKGROUND
  ACTRN12615000607572.
authors.affiliation: Emergency Department, Cabrini, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Katherine J
authors.identifier: http://orcid.org/0000-0002-5313-5852
authors.initials: KJ
authors.lastname: Walker
authors.affiliation: Emergency Department, Cabrini, Melbourne, Victoria, Australia.
authors.forename: Will
authors.identifier: http://orcid.org/0000-0002-4042-0574
authors.initials: W
authors.lastname: Dunlop
authors.affiliation: Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Danny
authors.identifier: http://orcid.org/0000-0002-0131-623X
authors.initials: D
authors.lastname: Liew
authors.affiliation: Department of Biostatistics, Cabrini Institute, Melbourne, Victoria, Australia.
authors.forename: Margaret P
authors.identifier: http://orcid.org/0000-0001-7514-7558
authors.initials: MP
authors.lastname: Staples
authors.affiliation: Department of Education, Cabrini Institute, Melbourne, Victoria, Australia.
authors.forename: Matt
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Emergency Department, Cabrini, Melbourne, Victoria, Australia.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-1770-3517
authors.initials: M
authors.lastname: Ben-Meir
authors.affiliation: Emergency Department, Cabrini, Melbourne, Victoria, Australia.
authors.forename: Hamish Gordon
authors.initials: HG
authors.lastname: Rodda
authors.affiliation: Emergency Department, Cabrini, Melbourne, Victoria, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Turner
authors.affiliation: Business Intelligence Unit, Cabrini, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Phillips
mesh_terms: D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D006801:Humans; D007318:Inservice Training / Q000191:economics*; D008497:Medical Record Administrators / Q000193:education*; D010865:Pilot Projects; D014739:Victoria
keywords: comparitive system research; cost effectiveness; education, teaching; emergency care systems, efficiency; emergency department