Scribes in an Australian private emergency department: A description of physician productivity

Emerg Med Australas. 2014 Dec;26(6):543-8. doi: 10.1111/1742-6723.12314. Epub 2014 Oct 20.


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.

Keywords: doctor's assistant; efficiency; emergency medicine; organisational; performance indicator; scribe.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Australia
  • Efficiency, Organizational*
  • Emergency Medicine*
  • Emergency Service, Hospital / organization & administration*
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Physician Assistants*
  • Pilot Projects
  • Prospective Studies