scholarly journals How Hospital Pharmacists Spend Their Time: A Work-Sampling Study

2020 ◽  
Vol 73 (4) ◽  
Author(s):  
Daniel Wong ◽  
Andrea Feere ◽  
Vandad Yousefi ◽  
Nilufar Partovi ◽  
Karen Dahri
Keyword(s):  
Patient Care ◽  
General Hospital ◽  
Health Care Professionals ◽  
Richmond Hospital ◽  
Vancouver General Hospital ◽  
Direct Patient Care ◽  
Clinical Activity ◽  
Assessment And Evaluation ◽  
Work Sampling ◽  
Temps De Travail

Background: The expanded scope of pharmacist practice allows for increased comprehensive care and improved patient outcomes at the cost of increased workload and time demands on pharmacists. There are limited descriptive metrics for the time that pharmacists spend on various activities during the workday. An evaluation of the time spent on different activities would allow for potential optimization of workflow, with a focus primarily on devoting more time to direct patient care activities.Objective: To quantify the amount of time that hospital and clinic-based pharmacists spend on clinical activities, including direct and indirect patient care, and nonclinical activities. Methods: An observational fixed-interval, work-sampling study was conducted at 2 hospitals, Vancouver General Hospital and Richmond Hospital, both in British Columbia. Trained observers followed individual pharmacists for a set period. The pharmacists’ activities were recorded in 1-min increments and classified into various categories. Results: In total, 2044 min of activity, involving 11 individual pharmacists, were observed. Clinical activities accounted for 82% of total time, 12% (251 min) on direct patient care activities and 70% (1434 min) on indirect patient care activities. The most common direct clinical activity was conducting patient medication history interviews (73 min; 4% of total time), and the most common indirect clinical activity was assessment and evaluation (585 min; 29%). The most common nonclinical activities were walking (91 min; 4% of total time), looking for something (57 min; 3%), and teaching pharmacy students on practicum (60 min; 3%). Conclusions: Although the pharmacists spent most of their time on clinical activities, face-to-face time with patients (direct clinical activities) seemed low, which highlights an area for potential improvement. The pharmacists spent much more time documenting information in pharmacy-specific monitoring forms (i.e., assessment and evaluation) than they spent writing notes or recommendations in the chart, for sharing with other health care professionals. Keywords: time, work sampling, pharmacist, activitiesRÉSUMÉContexte : L’élargissement du champ d’activité du pharmacien permet d’améliorer la qualité des soins et les résultats pour le patient au prix d’une augmentation de la charge et du temps de travail des pharmaciens. Il existe peu de mesures descriptives temps que les pharmaciens consacrent à leurs diverses activités de la journée. Une évaluation de ce temps permettrait d’optimiser le flux de travail afin que l’accent puisse être mis principalement sur l’augmentation du temps réservé aux activités de soins directs des patients.Objectif : Quantifier le temps que passent les pharmaciens des hôpitaux et des cliniques à effectuer des activités cliniques, y compris des activités de soins directs et indirects, ainsi que des activités non cliniques.Méthodes : Une étude observationnelle par échantillonnage à intervalles fixes a été menée dans deux hôpitaux : le Vancouver General Hospital et le Richmond Hospital, tous deux en Colombie-Britannique. Des observateurs formés ont suivi chaque pharmacien en particulier pendant une période déterminée. Leurs activités étaient consignées par tranches d’une minute et classées en diverses catégories.Résultats : L’observation a porté sur des activités totalisant 2044 minutes réparties entre 11 pharmaciens. Les activités cliniques représentaient 82 % du temps total, 12 % (251 min) des activités étaient consacrées aux soins directs et 70 % (1434 min), aux soins indirects. L’activité clinique directe la plus courante consistait à mener des entrevues portant sur les antécédents pharmacothérapeutiques des patients (73 min, 4 % du temps total) et l’activité clinique indirecte la plus courante était l’évaluation (585 min, 29 %). Les activités non cliniques les plus courantes étaient la marche (91 min, 4 % du temps total), la recherche de quelque chose (57 min, 3 %) et la formation des étudiants stagiaires en pharmacie (60 min, 3 %).Conclusions : Bien que les pharmaciens consacrent la plus grande partie de leur temps à des activités cliniques, le temps passé auprès des patients (activités cliniques directes) semblait faible, ce qui indique une possibilité d’amélioration. Les pharmaciens passent beaucoup plus de temps à consigner de l’information dans des formulaires de contrôle spécifiques à la pharmacie (c.-à-d. évaluation) qu’à rédiger des notes ou des recommandations dans les tableaux pour les partager avec les autres professionnels de la santé.Mots-clés : temps, échantillon de travail, pharmacien, activités

Experience of an Interdisciplinary Pediatric Pain Service

PEDIATRICS ◽  
1991 ◽  
Vol 88 (6) ◽  
pp. 1226-1232
Author(s):  
Barbara S. Shapiro ◽  
David E. Cohen ◽  
Kenneth W. Covelman ◽  
Carol J. Howe ◽  
Sam M. Scott
Keyword(s):  
Sickle Cell Disease ◽  
Patient Care ◽  
Sickle Cell ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Direct Patient Care ◽  
Team Approach ◽  
Cell Disease ◽  
Number Of Patients ◽  
Physician Time

This article is a report of our experience with an interdisciplinary pain service in a large tertiary care pediatric hospital. During the first 2 years of operation, we received 869 consultations and referrals from more than 19 hospital divisions. Postoperative pain was the most frequent reason for consultation (56% of patients). Patients with pain related to cancer and sickle cell disease comprised 25% of the consultations. The remaining patients had a wide variety of primary diagnoses and causes of pain. We calculated the time spent by pain service physicians in direct patient care. The majority (63%) of physician time was spent with a small number of patients (17%). Most of these patients had pain that was unrelated to surgery, cancer, or sickle cell disease, and many posed dilemmas in diagnosis and treatment. Physician time was correlated directly to the use of psychologic and physical therapies for the pain, involving multiple team members. This experience supports the demand for an interdisciplinary pain service in a tertiary care children's hospital. A significant amount of physician time is necessary to provide patient care and to maintain a team approach, however, and pediatricians and other health care professionals who aim to implement such services should be cognizant of the time required.

The Time Needed for Clinical Documentation versus Direct Patient Care

2009 ◽  
Vol 48 (01) ◽  
pp. 84-91 ◽  
Author(s):  
H.-P. Spötl ◽  
E. Ammenwerth
Keyword(s):  
Patient Care ◽  
Health Care Professionals ◽  
Time Pressure ◽  
Direct Patient Care ◽  
Steady Increase ◽  
Clinical Documentation ◽  
Computer Based ◽  
Internal Medicine Wards ◽  
Tion System ◽  
Physician Job Satisfaction

Summary Objectives: Health care professionals seem to be confronted with an increasing need for high-quality, timely, patient-oriented documentation. However, a steady increase in documentation tasks has been shown to be associated with increased time pressure and low physician job satisfaction. Our objective was to examine the time physicians spend on clinical and administrative documentation tasks. We analyzed the time needed for clinical and administrative documentation, and compared it to other tasks, such as direct patient care. Methods: During a 2-month period (December 2006 to January 2007) a trained investigator completed 40 hours of 2-minute work-sampling analysis from eight participating physicians on two internal medicine wards of a 200-bed hospital in Austria. A 37-item classifica tion system was applied to categorize tasks into five categories (direct patient care, communication, clinical documentation, administrative documentation, other). Results: From the 5555 observation points, physicians spent 26.6% of their daily working time for documentation tasks, 27.5% for direct patient care, 36.2% for communication tasks, and 9.7% for other tasks. The documentation that is typically seen as administrative takes only approx. 16% of the total documentation time. Conclusions: Nearly as much time is being spent for documentation as is spent on direct patient care. Computer-based tools and, in some areas, documentation assistants may help to reduce the clinical and administrative documentation efforts.

An analysis of growth in the genetic counseling profession 2009 to 2019.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13526-e13526
Author(s):  
Gillian Hooker ◽  
Dawn C. Allain ◽  
Adam H Buchanan ◽  
Melanie Care ◽  
Laura Conway ◽  
...  
Keyword(s):  
Genetic Counseling ◽  
Patient Care ◽  
Health Care Professionals ◽  
Cancer Genetics ◽  
Genetic Counselors ◽  
Direct Patient Care ◽  
Cancer Genetic Counseling ◽  
National Society ◽  
Primary Specialty ◽  
Training Opportunities

e13526 Background: Genetic counselors (GCs) are health care professionals who provide support to patients and physicians navigating the rapidly changing landscape of genetic testing and the genetic underpinnings of disease. Increased demand for genetic counseling services prompted an analysis of changes in the workforce over the last decade. Methods: To quantify the growth in the GC profession in the U.S and Canada in the last decade, we acquired data from the American Board of Genetic Counseling, National Society of Genetic Counselors, Canadian Association of Genetic Counselors, Accreditation Council for Genetic Counseling and Association of Genetic Counseling Program Directors. Results: Between 2009 and 2019, the workforce more than doubled, growing from 2,205 ABGC-certified GCs to 5,172. In Canada, the number of CAGC-certified GCs has grown from 211 in 2009 to 327 in 2019. Growth is striking in cancer genetic counseling; the proportion of GCs providing direct patient care in North America who report cancer as a primary specialty has increased from 25% in 2008 to 50% in 2019. Similar growth has been seen in training opportunities for GCs. The number of accredited graduate programs has increased from 33 in 2009 to 51 in 2019, with several more in development. Combined, these programs had 464 training slots in 2019, up from 223 in 2009. In 2019, 1569 applicants registered for the applicant match for training. Training opportunities and clinical genetic counselors are concentrated in large metropolitan areas, with over half of GCs working in 28 metro regions. GC services in rural areas are increasingly provided remotely via telemedicine, with 59% of GCs in direct patient care in 2018 reporting providing services by phone and 19% using web or video services to deliver care. In cancer genetics, about 50% of GCs nationwide reported in 2018 their 3rd next available appointment for new patients was within 14 days. Conclusions: The past decade has seen significant growth in the numbers of GCs and more patients have access to GCs than a decade ago. Reimbursement for services remains a significant barrier to access. Further research is warranted to understand additional political, administrative and logistical facilitators and barriers to providing care to all who need genetics services.

scholarly journals Making sense of symptoms, clinicians and systems: a qualitative evaluation of a facilitated support group for patients with medically unexplained symptoms

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michelle Marcinow ◽  
Jane Sandercock ◽  
Chelsea D’Silva ◽  
David Daien ◽  
Carly Ellis ◽  
...  
Keyword(s):  
Patient Care ◽  
Support Group ◽  
Health Care Professionals ◽  
Patient Population ◽  
Clinical Care ◽  
Medically Unexplained Symptoms ◽  
Lessons Learned ◽  
Direct Patient Care ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Abstract Objectives Health services to date have inadequately addressed the physical and mental health needs of patients with medically unexplained symptoms. This qualitative study evaluates a piloted facilitated support group (FSG) developed for patients with medically unexplained symptoms to inform recommendations and resources for this patient population. Methods Using a qualitative descriptive design, we conducted and thematically analyzed semi-structured interviews with participants (n = 8) and facilitators (n = 4) to explore their experiences of the facilitated support group. Common themes that captured strengths and challenges of the facilitated support group were identified. Results The following key themes were identified through analysis of the data: Participants described 1) feeling validated through sharing similar experiences with peers; 2) learning practical symptom management and coping strategies; and 3) gaining new perspectives for navigating conversations with PCPs. Conclusions Our findings show that a facilitated support group may provide additional forms of support and resources for patients with medically unexplained symptoms, filling a gap in currently available clinical care offered by health care professionals. Potential implications: This paper highlights lessons learned that can inform the design and delivery of future supports and resources directed toward optimizing patient care for this underserved patient population. Our findings are relevant to those who are involved in direct patient care or involved in designing and implementing self-management programs.

scholarly journals PREVENTION & CONTROL STRATEGIES FOR NOSOCOMIAL INFECTION

2021 ◽  
Author(s):  
Suriya Narayanan Harikrishnan ◽  
Dattatreya Mukherjee ◽  
Sufia Imam ◽  
Aayushi Raj Sinha
Keyword(s):  
Health Care ◽  
Nosocomial Infection ◽  
Patient Care ◽  
Nosocomial Infections ◽  
Health Care Professionals ◽  
Invasive Procedure ◽  
Healthcare Facility ◽  
Direct Patient Care ◽  
Hospital Treatment ◽  
Carrier Status

Nosocomial infection is every infectious process appearing during hospital stays, despite itsclinical picture carrier status and time of manifestation – during hospital treatment orafter discharge.A nosocomial infection is contracted because of an infection or toxin that exists in a certainlocation, such as a hospital. People now use nosocomial infections interchangeably with theterms health-care associated infections (HAIs) and hospital-acquired infections. For a HAI,the infection must not be present before someone has been under medical care.The responsibility of HAI prevention is with the healthcare facility. Hospitals andhealthcare staff should follow the recommended guidelines for sterilization anddisinfection. However, due to the nature of healthcare facilities, it’s impossible to eliminate100 percent of nosocomial infections.Prevention of nosocomial infections requires an integrated, monitored, programme whichincludes the following key components:(1.) limiting transmission of organisms between patients in direct patient care throughadequate handwashing and glove use, and appropriate aseptic practice, isolationstrategies, sterilization and disinfection practices, and laundry(2.) controlling environmental risks for infection(3.) protecting patients with appropriate use of prophylactic antimicrobials, nutrition,and vaccinations(4.) limiting the risk of endogenous infections by minimizing invasive procedure, andpromoting optimal antimicrobial use(5.) surveillance of infections, identifying and controlling outbreaks(6.) prevention of infection in staff members(7.) enhancing staff patient care practices, and continuing staff education.Infection control is the responsibility of all health care professionals — doctors, nurses,therapists, pharmacists, engineers and others.

scholarly journals Contamination of Healthcare Worker Personal Protective Equipment with MRSA Outside the Intensive Care Unit Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s27-s28
Author(s):  
Gita Nadimpalli ◽  
Lisa Pineles ◽  
Karly Lebherz ◽  
J. Kristie Johnson ◽  
David Calfee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Direct Patient Care ◽  
Care Group ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Contact Precautions ◽  
Patient Interactions ◽  
The Right

Background: Estimates of contamination of healthcare personnel (HCP) gloves and gowns with methicillin-resistant Staphylococcus aureus (MRSA) following interactions with colonized or infected patients range from 17% to 20%. Most studies were conducted in the intensive care unit (ICU) setting where patients had a recent positive clinical culture. The aim of this study was to determine the rate of MRSA transmission to HCP gloves and gown in non-ICU acute-care hospital units and to identify associated risk factors. Methods: Patients on contact precautions with history of MRSA colonization or infection admitted to non-ICU settings were randomly selected from electronic health records. We observed patient care activities and cultured the gloves and gowns of 10 HCP interactions per patient prior to doffing. Cultures from patients’ anterior nares, chest, antecubital fossa and perianal area were collected to quantify bacterial bioburden. Bacterial counts were log transformed. Results: We observed 55 patients (Fig. 1), and 517 HCP–patient interactions. Of the HCP–patient interactions, 16 (3.1%) led to MRSA contamination of HCP gloves, 18 (3.5%) led to contamination of HCP gown, and 28 (5.4%) led to contamination of either gloves or gown. In addition, 5 (12.8%) patients had a positive clinical or surveillance culture for MRSA in the prior 7 days. Nurses, physicians and technicians were grouped in “direct patient care”, and rest of the HCPs were included in “no direct care group.” Of 404 interactions, 26 (6.4%) of providers in the “direct patient care” group showed transmission of MRSA to gloves or gown in comparison to 2 of 113 (1.8%) interactions involving providers in the “no direct patient care” group (P = .05) (Fig. 2). The median MRSA bioburden was 0 log 10CFU/mL in the nares (range, 0–3.6), perianal region (range, 0–3.5), the arm skin (range, 0-0.3), and the chest skin (range, 0–6.2). Detectable bioburden on patients was negatively correlated with the time since placed on contact precautions (rs= −0.06; P < .001). Of 97 observations with detectable bacterial bioburden at any site, 9 (9.3%) resulted in transmission of MRSA to HCP in comparison to 11 (3.6%) of 310 observations with no detectable bioburden at all sites (P = .03). Conclusions: Transmission of MRSA to gloves or gowns of HCP caring for patients on contact precautions for MRSA in non-ICU settings was lower than in the ICU setting. More evidence is needed to help guide the optimal use of contact precautions for the right patient, in the right setting, for the right type of encounter.Funding: NoneDisclosures: None

scholarly journals Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

2021 ◽  
Vol 12 (01) ◽  
pp. 141-152
Author(s):  
Vimla L. Patel ◽  
Courtney A. Denton ◽  
Hiral C. Soni ◽  
Thomas G. Kannampallil ◽  
Stephen J. Traub ◽  
...  
Keyword(s):  
Patient Care ◽  
Emergency Departments ◽  
Direct Patient Care ◽  
Team Communication ◽  
Delivery Of Care ◽  
Physician Practices ◽  
Clinical Observations ◽  
Workflow Pattern ◽  
Open Coding ◽  
Temporal Events

Abstract Objectives We characterize physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) are explored within the context of organizational complexity for the delivery of care. Methods Two urban clinical sites, including an academic teaching ED, were selected. Fourteen physicians were recruited. Overall, 62 hours of direct clinical observations were conducted characterizing clinical activities (EHR use, team communication, and patient care). Data were analyzed using qualitative open-coding techniques and descriptive statistics. Timeline belts were used to represent temporal events. Results At site 1, physicians, engaged in more team communication, followed by direct patient care. Although physicians spent 61% of their clinical time at workstations, only 25% was spent on the EHR, primarily for clinical documentation and review. Site 2 physicians engaged primarily in direct patient care spending 52% of their time at a workstation, and 31% dedicated to EHRs, focused on chart review. At site 1, physicians showed nonlinear complex workflow patterns with a greater frequency of multitasking and interruptions, resulting in workflow fragmentation. In comparison, at site 2, a less complex environment with a unique patient assignment system, resulting in a more linear workflow pattern. Conclusion The nature of the clinical practice and EHR-mediated workflow reflects the ED work practices. Physicians in more complex organizations may be less efficient because of the fragmented workflow. However, these effects can be mitigated by effort distribution through team communication, which affords inherent safety checks.

scholarly journals Building capacity for implementation—the KT Challenge

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Agnes T. Black ◽  
Marla Steinberg ◽  
Amanda E. Chisholm ◽  
Kristi Coldwell ◽  
Alison M. Hoens ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Professionals ◽  
Qualitative Data ◽  
Practice Change ◽  
Evidence Based ◽  
Science Literature ◽  
Health Care Settings ◽  
Improvement Programs ◽  
The Impact

Abstract Background The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change. Methods The evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics. Results Participants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. Conclusions The KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

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