Background: Emergency Physicians and trainees spend the majority of their clinical day performing clerical tasks which are widely disliked(Füchtbauer LM, 2013). Core tasks such as obtaining information, cognitive synthesis and communication are punctuated with other tasks including hours of electronic hospital record data entry, relaying information to multiple colleagues, sending investigation requests, booking beds, coordinating patient movements and chasing investigations(Kee R, 2012). In addition to reducing physician productivity and contributing to work place dissatisfaction, the clerical tasks performed by doctors are a waste of medical resources. Patients need physicians to be available to them, rather than spending 30-43% (Robert G. Hill Jr., 2013)of their shift on clerical data entry requiring multiple “mouse clicks” for even simple tasks. Many of these non-core tasks may be amenable to task substitution leaving Emergency Physicians free to focus on “doctoring”.
Emergency Medicine scribes (“scribes”) may or may not be a partial solution (Bastani A, 2014)to Emergency Department (ED) workforce capacity building. Scribes function as a bedside clerical assistant to the physician. They are becoming more common in the US, but not elsewhere. Scribes cost money, which represents a health opportunity cost. There have been a number of emergency studies that have evaluated before and after scribe implementations (Hess JJ, 2015)(Arya R, 2010)and one single-centre study that randomised scribes to pediatric and adult areas of their ED (Heaton HA, 2016). There have not been any independently-funded, level II evidence studies about the effect of the scribe on emergency department metrics, nor any published information regarding patient safety.
An Australian collaboration (philanthropically funded) recently undertook a prospective, multicentre randomised trial of scribes in the Emergency Department and their results were published in the BMJ in January 2019. Read more →