OCEANSIDE: Hospital uses scribes in the ER

Med students use high-tech tablets to help emergency docs

By PAUL SISSON - Staff Writer | Wednesday, April 2, 2008 12:14 PM PDT ∞

OCEANSIDE --- The word "scribe" implies a wizened old man, drawing arcane symbols on a clay tablet. Not so at the emergency room of Tri-City Medical Center, where modern-day scribes jot notes into hand-held wireless computers, creating patient records for doctors in real time.

Dr. Reid Conant, an emergency medicine specialist at Tri-City, said the public hospital is one of the first in the nation to give high-tech notepads to a part-time crew of about 50 pre-med students and ask them to follow emergency doctors on their rounds, recording patient histories and medical observations as they are made.

"Only one or two other hospitals in the country are using this scribe and tablet system the way we are using it," Conant said.

The idea, he said, is to create a digital patient record as soon as a patient walks through the door.

Scribes, who receive 40 to 50 hours of training from Scribe America, a private San Diego-based firm, jot notes directly into a tablet that uses handwriting recognition to quickly convert longhand into text. Doctors review each record before it becomes part of a patient's medical history.

Conant said the new system, which has now been in operation at Tri-City for one year, gives him more time to focus on his patients.

"I have more time to do the doctoring thing as opposed to the clerical thing," Conant said.

Dr. Kerry Mells, another emergency department specialist, agreed. He said the digital system also creates better patient records because they are entered immediately.

In the old days of paper documents, Mells said he would make his rounds and then sit down at his desk to complete patient charts, drawing from notes he made at the bedside and from his recollection of what he observed during examinations.

"We just get a much more accurate record when it's done in real time," Mells said.

Conant added that scribes have more time to flesh out a given record because note-taking is their only obligation.

"We get a much beefier, more complete record than we would otherwise," Conant said.

On a recent afternoon, scribe Jillian Perez, who recently graduated from the University of California at San Diego with a pre-med degree in psychology, said she will soon begin applying to medical schools. Perez said serving as a scribe is the best gig she could find to help prepare her for a career as a physician.

"A lot of the other pre-med students, they are working in labs," she said. "But we are with the doctors. We're learning a lot of the vocabulary, the way things are really done."

Mells said Tri-City's emergency room saw 67,000 patients in 2007, up from 62,500 in 2006. Despite a 13 percentage point increase in patient volume, the doctor said the emergency room saw a 21 percent decrease in wait times over that same one-year stretch. Though he said he believes scribes save time, he was not sure exactly how much, because other measures, such as an additional CT Scanner exclusively for the ER, have also been installed recently to help shrink wait times.

In the old days, doctors would dictate their notes into a tape recorder and the hospital's pool of transcriptionists would transcribe those spoken notes into paper records. But with the scribe system those records become available much more quickly not just to the emergency room, but to any nurse or doctor who is involved with continuing the patient's care.

"As soon as we sign it, it's available to anyone with the proper credentials," Mells said. "That's much faster than waiting for transcription."

Tri-City, which pays scribes $10 per hour for their services, has started to get some notice from the larger medical world for its scribe program. Conant said doctors and hospital administrators regularly visit to observe the program in action.

"We've had them come from as far away as Maryland and Vancouver," Mells said.

Contact staff writer Paul Sisson at (760) 901-4087 or psisson@nctimes.com. Comment at nctimes.com.

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