Measuring pharmacy clinical workload in the emergency department: Current status and a plan for action

Abstract

Background

Inpatient pharmacy productivity workload ratios historically encompass dispensing functions including numbers of medication orders verified, dispensed, and billed for and full-time equivalents (FTEs) but do not include pharmacy clinical activities. Clinical pharmacy activities are difficult to capture because they generally require manual documentation and vary among health systems. The emergency medicine pharmacists’ (EMPs) role adds additional complexity to capturing clinical activities given that bedside response and verbal recommendations are difficult to capture outside of manual documentation. It is unknown how many health systems use EMP-specific workload metrics.

Objectives

The purpose of our survey was to determine the percentage of hospital pharmacies that use EMP-specific workload metrics, to describe workload metrics used by EMPs and to quantify time spent on clinical activities, and to describe methods for implementing EMP metrics.

Methods

A 13-item questionnaire was developed, pretested, and sent to EMPs practicing in hospitals in the United States through 2 EMP national committee e-mail listservs. Survey completion online included questions on hospital characteristics, number of EMP FTEs, clinical services provided and time spent on these tasks, and current workload metrics used.

Results

Full responses to the survey were received from 100 pharmacists, with an overall response rate of 9.8%. Workload metrics specific to EMP activities were used by 15.1% of responders. Workload metrics were used but not tailored to EMP activities for 43% of responders, and 41.9% responded that no metrics were used whatsoever. Ten responders provided commentary on types of EMP activities tracked, which included bedside response for critical patients, culture callback, drug information and dosing, time to antibiotic administration, and medication histories. No universal software for metric tracking was identified.

Conclusion

A survey of EMP clinical services and workload metrics indicated that although 43% of responders use non-EMP-specific metrics, only 15.1% reported workload metrics that capture EMP clinical activities.