Should All Doctors Be Given Secretaries? Using Medical Students As Admin Support

Using medical students as admin support helps consultants care for 15% more patients an hour

• Scribes record details of the consultation, arrange tests and print paperwork
• In a study, the admin support reduced a patient's emergency care stay by 19mins
• Cost analysis found scribes put hospitals in a 'favourable financial position'

Doctors may benefit from using medical students as scribes, research suggests.

A scribe stands at a patient's bedside documenting details of the consultation, arranging tests and printing paperwork - allowing the medics to focus on treating the problem at hand.

A study comparing the use of scribes in 589 shifts to 3,296 shifts without the admin support found they increased the number of patients a doctor saw every hour by 15.9 per cent.

Scribes also reduced the amount of time the average patient stayed in a hospital's emergency department by 19 minutes.

After carrying out a cost-benefit analysis, the researchers claim hiring scribes puts hospitals in a 'favourable financial position'.



Doctors may benefit from using medical students as scribes, research suggests

The research was carried out by Cabrini Hospital in the Melbourne suburb of Malvern and led by Dr Katie Walker, director of the scribe programme.

Writing in the BMJ, the authors said: 'Given the strong preference of physicians for working with a scribe, no effect on the patient experience, minimal risk, and the productivity and throughput gains outlined...

'Emergency department and hospital administrators should strongly consider the potential local utility of scribes in their workforce and financial planning.'

The researchers analysed the use of 12 scribes across five emergency departments in public and private hospitals in the state of Victoria from November 2015 to January this year.

The scribes - who were medical or pre-medical students - assisted 88 emergency consultants or senior registrars during a total of 589 routine shifts.

The doctors' productivity - defined as the number of patients they treated - was compared against 3,296 shifts carried out without scribes.

The medics also self reported on how useful they found the scribes.

Results revealed the scribes increased the doctors' productivity by 15.9 per cent from an average of 1.13 patients an hour per medic to 1.31.

It also improved the number of primary consultations - where the medic is the main doctor overseeing the patient - by 25.6 per cent from 0.83 to 1.04 patients an hour.

The amount of time the patients spent in hospital was also reduced by 19 minutes from 192 minutes to 173.

But the scribes did not change the amount of time the patients had to wait before being seen.

Scribes were found to be most useful when working alongside senior doctors at triage - where the severity of injury, and order of treatment, is decided.

But they did not help in fast-track care - when a patient is deteriorating and their condition is becoming terminal.

In terms of safety, one 'incident' occurred in every 300 consultations, of which 44 per cent were related to patient identification.

But in around half of the incidents, the scribes helped stop it turning into a medical error.

However, self-reporting the incidents may mean the results are an underestimation, the researchers claim.

A cost-benefit analysis revealed that if a hospital covered the cost of training, scribes could save the hospital US$26.15 (around £19.99) an hour.

And if the scribe paid for their own training, it would save the hospital US$31.15 (£23.81) every 60 minutes.

The study did not investigate the number of times a patient asked for a scribe not to be present, but past research suggests it occurs in less than one per cent of consultations.

The researchers stress future studies should investigate the pros and cons of scribes in settings other than emergency departments.

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