P030: Role of scribes in emergency care in the Saskatoon health region

Abstract

Introduction: Increasingly, hospitals are adopting electronic charting systems. Recent literature suggests that physicians are spending roughly 2:1 hours on charting as compared to actual patient care raising questions as to whether manual electronic charting is the best use of scarce physician resources. To counter these effects, some hospitals have introduced scribes into their departments. A medical scribe is a person, or paraprofessional, who specializes in charting physician-patient encounters in real time. In this pilot study, we assessed the impact of having a scribe on the mental and physical fatigue, patient and healthcare-team engagement, and overall work satisfaction of emergency physicians at an urban emergency department (St. Paul’s Hospital, Saskatoon). Methods: Three research participants (emergency physicians) were recruited to the study. Each participant completed a typing test to determine typing skills. The student researcher then provided scribe services for each participant for two shifts. The scribe charted physician-patient interactions in real time and also completed order sets, wrote orders, imaging requisitions, and prescriptions. Physicians completed surveys after each shift with the scribe as well as after 2 shifts without a scribe (for a total of 12 shifts in the study, 6 with the intervention). Physicians were asked to rate their mental and physical fatigue, enjoyment of work, and impact on patient/team engagement on a 10-point Likert scale. Results from the questionnaires were analyzed to determine individual and group mean responses. Given the small sample size, no further statistical calculations were completed. Results: Typing test results (in words per minute) were as follows: Scribe 93, Physician A 64, Physician B 40, Physician C 25. In terms of both mental and physical fatigue post shift, all 3 participants recorded being less fatigued after working shifts with a scribe. Mean group scores were as follows: mental fatigue decreased by 33%, physical fatigue decreased by 23%. Physicians work enjoyment improved by 10%. Team and patient interaction did not seem impacted by the intervention. Conclusion: It appears that regardless of typing skills, all physician participants noted a measurable benefit from having a scribe on shift. This suggests that off-loading documentation to the scribe has a positive effect on mental and physical endurance. These results warrant further investigations.