RCT - Scribes Increase Productivity and Profit

Written by Clay Smith

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Scribes were a benefit to physician productivity and profit in this multicenter Australian RCT. The only question - is it time for your group to start utilizing them?

Why does this matter?
Several observational studies have shown benefit in the number of patients seen per hour and in profit with use of scribes, although reviews have been mixed. Not to mention, scribes seem to make clinicians happier.

Woe to you, scribes and Pharisees…or not
This was an Australia-based multicenter RCT with a diverse assortment of hospitals included, with 88 physicians randomized to work routine clinical shifts with or without a scribe. The number of patients went up from 1.13 per hour to 1.31, nearly a 16% increase. Scribes also reduced length of stay by 19 minutes. The biggest impact was in use of scribes with senior doctors in triage, and the least benefit was seen in low-acuity fast track settings. They didn’t identify any harms, although the wrong patient record was accessed and incorrect orders entered a few times, all of which were caught (half the time by the scribe). But who hasn’t done that? Overall, scribes were a net positive benefit financially, with estimated savings of $25 per hour of physician time when a scribe was working (based on a 15% increase in productivity). This is the best quality evidence to date on scribes in the ED. It is hard to see a downside - happier physicians, better productivity, and greater income. Seems like a no-brainer.

Source
Impact of scribes on emergency medicine doctors' productivity and patient throughput: multicentre randomised trial. BMJ. 2019 Jan 30;364:l121. doi: 10.1136/bmj.l121.

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Reviewed by Thomas Davis

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