New attendances at emergency departments in the UK continue to increase. There were 11.3 million new attendances in 1981, rising to 16 million in 1999. ¹ Combined with the government’s drive to reduce waiting times, this has resulted in considerable strain being placed on doctors to see, treat and discharge or admit patients quickly, while maintaining accurate records.

One method suggested to reduce doctors’ time spent on administration is for discharge documents to be dictated rather than hand-written for all patients sent home directly from the emergency department.

We performed a pilot study assessing whether there was any variance in the quality and content of hand-written versus dictated accident and emergency discharge documentation between two sites in National Health Service Fife. The senior health officers of the accident and emergency department work between the two sites, and facilities for dictation are only available at one of these. This allowed for comparison while eliminating inter-doctor variance. A total of 372 discharge documents were assessed for legibility, the presence or absence of formal diagnoses, investigation results, analgesia given and outcome (discharged, referred or admitted). Dictated documents were superior in every category. Legibility was a particular problem, with 6.6% of hand-written documents being largely illegible. Diagnoses were more often present in dictated records (88% v 69.7%; p <0.01), and, when present, were more often highlighted or obviously located (84% v 44.3%; p <0.01). Radiology results (90% v 81%), analgesia given (100% v 91.7%) and outcome (92% v 86.1%) were also disparate, although these did not achieve statistical significance.

With other studies showing that dictation is faster, improves doctor’s satisfaction and departmental productivity,² and that their quality is less adversely affected by increased workload,³ we think this is an area that deserves further attention and hope to conduct a larger-scale study in the near future.