None listed
Conditions
Brief summary
Medical scribes are clerical assistants to doctors. ED docs currently spend 48% of their time on clerical data entry into computers. Scribes undertake secretarial/clerical data entry tasks in Emergency departments to enable the doctor to leave their desk and get back to the bedside to treat more patients in a safe, cost-effective way. There is economic equipoise about whether the scribe role should be introduced to Australia. Work to date has been undertaken at Cabrini ED and shows promise. There is a need for a mulit-centre public ED evaluation of the role. There is no equivalent study anywhere in the world. We are undertaking a multi-centre randomised controlled trial of scribes, using Australian scribes we have trained at Cabrini this year in a research capacity. Cabrini is auspicing the study and the principle investigator is Dr Katie Walker. Scribes will be randomly allocated to consenting doctors to work at each site for 5 months FTE (100 scribed shifts and 100 control shifts at each site) and administrative data on consultations per hour per doctor will be gathered. We will evaluate the role and its impact on medical productivity in four sites which represent typical public Emergency departments across Victoria and Australia. The sites are Bendigo, Austin, Monash Paeds and Dandenong. We have gathered a team of national and international experts who work in Victoria to ensure robust delivery of the project with expert methodology and execution. We have the only medical scribe workforce available in Australia ready to participate. This will enable a determination on whether scribes provide a cost-effective way of delivering medical care in Australian EDs.
Interventions
Medical scribe use by Emergency Doctors.
A trained medical scribe will assist an emergency doctor during emergency consultations. Doctors will be allocated scribes by randomisation of scribes into available shifts. They may work with one or more scribes over the whole study, but only with one scribe per clinical shift.
The training the scribes have received is a pre-work course with additional tutorials and simulation training, followed by observer shifts as a trainee with gradually increasing
Medical scribe use by Emergency Doctors. A trained medical scribe will assist an emergency doctor during emergency consultations. Doctors will be allocated scribes by randomisation of scribes into available shifts. They may work with one or more scribes over the whole study, but only with one scribe per clinical shift. The training the scribes have received is a pre-work course with additional tutorials and simulation training, followed by observer shifts as a trainee with gradually increasing responsibility (between 7 and 16 clinical shifts). They are deemed to be competent when they have undertaken three shifts in a row and been evaluated as competent after each shift on a modified Angoff scribe performance score. Scribes will take clinical consultation notes as directed and will assist with clerical tasks as directed. Scribes will be randomly allocated to shifts of public Emergency Department doctors in Victoria (at enrolled sites) over a one year period from November 2016 to October 2017. Each site will require 100 clinical shifts and 100 controls. We estimate that this will require 3 months of 1 EFT of scribe per site. Scribes will also be required to work initial orientation shifts at each new site prior to commencing collecting study data (to learn the site processes and electronic medical record functionality). We estimate this period to be 2 weeks per site. There will be no minimum or maximum number of shifts for a physician to be exposed to, however it is likely that 4 physicians will be required per site - anticipating an even spread of about 12-13 shifts per physician at each site.
Sponsors
Dr Katherine Walker
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
23 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Emergency department doctors: working at each site during the sampling time period working at least two clinical shifts per week performing a clinical patient consultation role either consultants or senior registrars
Exclusion criteria
Doctor unwilling to consent to participate
Outcome results
None listed