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An economic evaluation of the costs of training a medical scribe to work in Emergency Medicine
  1. Katherine J Walker1,2,
  2. Will Dunlop1,
  3. Danny Liew2,
  4. Margaret P Staples3,
  5. Matt Johnson4,
  6. Michael Ben-Meir1,
  7. Hamish Gordon Rodda1,
  8. Ian Turner1,
  9. David Phillips5
  1. 1Emergency Department, Cabrini, Melbourne, Victoria, Australia
  2. 2Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3Department of Biostatistics, Cabrini Institute, Melbourne, Victoria, Australia
  4. 4Department of Education, Cabrini Institute, Melbourne, Victoria, Australia
  5. 5Business Intelligence Unit, Cabrini, Melbourne, Victoria, Australia
  1. Correspondence to Dr Katherine J Walker, Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, VIC 3144, Australia; katie_walker01{at}yahoo.com.au

Abstract

Objective To undertake a cost analysis of training medical scribes in an ED.

Methods This was a pilot, observational, single-centre study at Cabrini ED, Melbourne, Australia, studying the costs of initiating a scribe programme from the perspective of the hospital and Australian Health sector. Recruitment and training occurred between August 2015 and February 2016 and comprised of a prework course (1 month), prework training sessions and clinical training shifts for scribe trainees (2–4 months, one shift per week) who were trained by emergency physicians. Costs of start-up, recruitment, administration, preclinical training, clinical training shifts and productivity changes for trainers were calculated.

Results 10 trainees were recruited to the prework course, 9 finished, 6 were offered clinical training after simulation assessment, 5 achieved competency. Scribes required clinical training ranging from 68 to 118 hours to become competent after initial classroom training. Medical students (2) required 7 shifts to become competent, premedical students (3) 8–16 shifts, while a trainee from an alternative background did not achieve competency. Based on a scribe salary of US$15.91/hour (including 25% on-costs) plus shift loadings, costs were: recruitment and start-up US$3111, education US$1257, administration US$866 and clinical shift costs US$1137 (overall cost US$6317 per competent scribe). Physicians who trained the clinical trainee scribes during shifts did not lose productivity.

Conclusions Training scribes outside the USA is feasible using an on-line training course and local physicians. It makes economic sense to hire individuals who can work over a long period of time to recoup training costs.

Trial registration number ACTRN12615000607572.

  • comparitive system research
  • cost effectiveness
  • emergency care systems, efficiency
  • emergency department
  • education, teaching

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Footnotes

  • Contributors KJW is guarantor for the paper. Funding: KJW and MB-M; Methods design: KJW, MJ, DL and DP; Statistical methods: MJ and WD; Data collection: KJW, WD, DP and IT; Education development: KJW, MJ and IT; IT development: HGR and KJW; Write-up: KJW, WD, MPS and DL; Revision of write-up: all authors.

  • Funding Equity trustees, the Cabrini Foundation and Cabrini funded the study.

  • Competing interests KJW reports funding from equity trustees, Cabrini and the Cabrini Foundation, to evaluate scribe feasibility in Australia. She is the director of the scribe programme at Cabrini which has been established in a research capacity, and she has published previously in this area of research. KJW and Cabrini have no commercial interests in this topic. The grant agencies have not been involved in the research other than to provide funding.

  • Ethics approval Cabrini Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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