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Scribes help increase physician productivity and shorten patients' stay in the emergency, without significant risk to patient safety, suggest the results of a randomized trial published in The bmj aujourd & # 39; hui.
Medical scribes help doctors by performing administrative tasks. For example, documenting medical consultations while the doctor is badessing a patient, printing documents, and arranging tests and appointments – give the doctor time to see more patients.
Most doctors find scribes useful, but little research has been conducted on the economic benefits of using scribes in emergency services. And there has been no badessment of incidents related to patient safety related to patient safety.
In order to further their research, the researchers examined the productivity of physicians, working with and without scribes in five Australian emergency departments between November 2015 and January 2018.
The scribes, who were all medical or pre-medical students, had been trained before the study and then randomly badigned to the routine teams of doctors.
The researchers reviewed data from 589 teams rated (5,098 patients) and 3,296 undescribed units (23,838 patients) and compared their productivity.
In most study sites, the presence of scribes was linked to increased productivity, especially during primary consultations: scribes increased the number of patients per hour and per physician by 15.9% in total and 25.6% for primary consultations.
There was no change in the time of the doctor's appointment, but patients remained 19 minutes less in the presence of a scribe.
The presence of scribes was more effective when they were accompanied by experienced triage physicians (physicians badessing and prioritizing potential emergencies, ordering tests and starting certain treatments, before patients saw a doctor in the main emergency department. ).
No significant harm involving scribes has been reported – 1 consultation out of 300 reported reported a patient safety incident, which primarily involved incorrect identification of the patient and ordering tests.
And in half of the reported incidents, the scribe has been active in preventing a medical error, say the authors.
The researchers also carried out a cost-benefit badysis showing that, based on the productivity and time spent by patients in the hospital, the use of scribes would save $ 26.15 per hour if the hospital paid the training fee and $ 31.15 per session hour if the scribe paid for the training.
The authors point out that the results are based on five Australian emergency departments and that, therefore, the results may not be applicable to all hospitals. And reports of security incidents were disclosed voluntarily, which could have skewed the results, they add.
But they say it's the first multicenter, randomized study to evaluate the impact of scribes on physician productivity, including the occurrence of patient safety incidents.
The study also examined the impact of scribes in different types of emergency services "serving very different patient populations," they add, although "future work should include scribal testing in other settings. and country ".
Almost all health services have problems with requests that do not match available resources, write the authors.
"Given the strong preference of physicians to work with a scribe, no effect on the patient's experience, minimal risk, as well as productivity and flow rate gains described, the administrators of the emergency services and hospitals should strongly consider the local utility of scribes in their planning, "they conclude.
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