Scribe (ER)
An ER scribe works in the emergency department (ED) of a hospital. Their duties may include overseeing the documentation of each patient's visit to the ED and acting as the physician's personal assistant. A scribe works with one physician per shift and is generally assigned as that physician's personal scribe (often working regularly with the same physician), although they may work for multiple doctors.
A prospective scribe is required to learn a large and extensive amount of medical terminology, as well as become familiar with human anatomy. Each program has their own training regimen and some are more structured than others. For example, some programs require that all new scribes take an official graded course prior to working which includes extensive knowledge. Other programs allow the scribe to start in the ED immediately, but only under supervision which is sometimes referred to as bedside training, that is gradually reduced. Training is extremely intensive and lasts from as little as three shifts, to about one month under the direct supervision of an experienced scribe.
The first scribe programs were based in Reno, Nevada. In 1995 Dr. Elliott Trotter, M.D., a physician practicing in Fort Worth, Texas discovered the Nevada program and decided to start a program at Harris Methodist Hospital. The program has grown larger and spawned "copy" programs in several other cities. Some of these programs have retained the original program paradigm, while others have elected to create their own from scratch, using the original as a template. Technology advances have seen the introduction of "portable tablets" within some hospitals thus reducing the risk of error in scribe transcription.
There are a few programs, however, that have expanded beyond the original model and its core subjects, including more pertinent and up to date information. Even fewer programs have included advanced training levels beyond the basic training received by all scribes. These programs utilize standardized tests to certify scribes as being adequately prepared to work in a clinical environment. They also include periodic updates to keep the programs on the "leading edge" of medicine.
For each patient seen in the ED, a scribe will:
- Accompany the physician into the exam room
- Document the history of the patient's present illness
- Document the Review-of-Systems (ROS) and physical examination
- Enter vital signs and keep track of lab values
- Look up pertinent past medical records
- Keep track of and enter the results of imaging studies
- Prioritize the physician's time by bringing critical lab results to his/her attention
- Type progress notes
- Enter the patient's discharge plan and any prescriptions
Scribe positions are often filled by college students pursuing careers in medicine with some organizations providing assistance with college fees. Many plan to attend medical school and earn their MD or DO degree. A smaller number plan on becoming a physician assistant (PA). Pre-health students benefit from the experience they gain working in the emergency department. These students are also able to build relationships with medical practitioners who are usually willing to write letters of recommendation for professional school applications on the students' behalf. Some scribe organizations have opted to not hire college students pursuing medical careers, due to the subsequent high rate of attrition. Also, due to this relationship between the doctor, scribe and professional school applications, some scribe programs limit the positions to seniors of undergraduate programs.
Currently there are a number of scribe providers in the United States.