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

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

MP03: Strategies to minimize impact of electronic health record implementation on emergency department flow

Introduction: Electronic health record (EHR) implementation can be associated with a slowdown in performance and delayed return to pre go-live productivity. The objective of this study is to describe the impact of a go-live strategy including diversion, public advertising of the go-live, and extra physician staffing to mitigate productivity loss. Methods: Lions Gate Hospital (LGH), an urban community hospital and rural referral centre with 250 beds and 65,000 annual ED visits went live with Cerner HER (Cerner Corporation, Kansas, MO) on April 28, 2018. The implementation included complete electronic ordering and electronic physician documentation. We compared patients seen per hour, time to physician (TTMD), ED length of stay (EDLOS), patients per hour left without being seen (LWBS), and admission rate (AR) for the 6 weeks prior to implementation (Pre), 2 weeks during (Imp), and 6 weeks after (Post) for LGH and a control hospital (Richmond Hospital – comparable in size/acuity) for the same periods. Medians were compared using the Mann-Whitney test for patients/hour, EDLOS and TTMD, and chi-square for AR and LWBS. Results: Patients/hour seen went from 2.1/hour in the pre phase, but dropped to 1.7/hr in the 2 week period following implementation (P < 0.05). During weeks 2-8 post implementation, 2,3 patients per hour were seen (P = 0.38 compared to Pre phase). At the control hospital, patients per hour were comparable across all time periods (Ps > 0.3). Median time to physician was 54, 56, and 54 minutes at LGH for the Pre, Imp, and Post time periods (Ps > 0.3). Median EDLOS was 184, 196, and 184 minutes in the pre, Imp, and post phases (P Imp versus pre = 0.11; Pre versus post = 0.54). LWBS rate was 1.3%, 2.9, and 2.4% (Ps for Imp and Post versus pre <0.05) at LGH, but the pattern was similar for the control hospital (2.9%, 4.1% and 4.0%’ Ps <0.05). There was no significant change in ambulance arrivals or admission rate at either hospital (Ps > 0.2). Conclusion: A deliberate implementation strategy that focuses on ED physician upstaffing and visit diversion can smooth the impact of the implementation of an EHR so that patient care is not impacted significantly. Return to normal productivity occurred by 8 weeks post go-live. We demonstrate a strategy that may support easier implementation at other sites.

Dracula (1897), Bram Stoker

Bram Stoker (1847–1912) came from an Irish medical family whose influence is not hard to detect in his most famous work, Dracula, which sadly did not bring him the fame and fortune which his older brother William Thornley achieved. The latter was not only President of the Irish College of Surgeons and knighted, but held appointments at the two major Dublin asylums – the Richmond Hospital and St Patrick's. He was even a member of the Medico–Psychological Society for a while, and thus was well-placed to advise on the activities and thought-processes of the doctors in Dracula.

In conversation with Desmond McGrath

Dr McGrath was born in Liverpool in 1922. He was Medical Director of St John of God Hospital from January 1955 until December 1991 and Consultant Psychiatrist, St Laurence's (Richmond) Hospital (Beaumont Hospital from 1987), Dublin from 1956 until 1988. He was a Foundation Fellow of the Royal College of Psychiatrists and was a member of Council from 1974 to 1979, a member of the Court of Electors from 1979 to 1982 and Chairman of the Irish Division from 1974 to 1977. He was a member of Council and Censor of the Royal College of Physicians of Ireland from 1980 to 1982 and Chairman of the Section of Psychiatry of the Royal Academy of Medicine in Ireland from 1973 to 1975. He was President of the Medico-Legal Society of Ireland from 1966 to 1968 and has served on the Fitness to Practice Committee of the Medical Council of Ireland since 1989 and the Mental Health & Neurology Committee of the Medical Research Council of Ireland from 1969 to 1991.

Gordon Morgan Holmes, 1876-1965

Gordon Morgan Holmes was born in Dublin on 22 February 1876, the son of Gordon Holmes and his wife Kathleen Morgan). There were three brothers and a sister all of whom survive. The family is believed to have come to Ireland from Yorkshire and to have been settled in King’s County during the last of the Cromwellian plantations at the time of the Acts of Settlement in 1652. Holmes’s mother acquired by inheritance Dellin House and property at Castle Bellingham, Co. Louth, just south of the Ulster border, and this then became the family home and was farmed by his father. In complexion, physique and predominantly in temperament, Holmes was indubitably an Irishman, and during the centuries Irish blood must have mingled with the English strain. His mother died while he was a child and his formal education began late. He has said that he taught himself to read, but it is recalled that later in the village school his schoolmaster discerning unusual ability in the lad voluntarily gave him extra tuition. Thence he went as a boarder to the Dundalk Educational Institute where his schooling was completed. The school had a reputation for turning out good mathematicians, and when Holmes went up to Trinity College, Dublin, his choice wavered between reading mathematics or classics. But he was a determined walker, and had rapidly grown to love the Wicklow Hills, so easily within reach of Dublin, and to develop an interest in their flora. He thus decided to read natural science, was attracted by botany and biology, and so became a medical student. In 1897 he took his B.A., Senior Moderator in Natural Science, graduated in medicine in 1897 and proceeded M.D. in 1903. During his course he took a number of scholarships and a travelling prize. His hospitals were the Sir Patrick Dunn’s and—after graduation—the Richmond Hospital.