How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

Abstract

Background Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician’s responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs. Methods An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021. Results In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians’ work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks. Conclusion In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.

How Do Pharmacists Distribute Their Work Time during a Clinical Intervention Trial?—A Time and Motion Study

“…Our results show that pharmacists spent 42% of their work time to MedRec, MedRev, and other medication-related activities, which are crucial for optimizing patient outcomes and facilitating care transitions [ 27 , 28 , 29 , 30 ]. This is far more than the time that both ED nurses and physicians, who devoted only 3.3% and 8.7%, respectively, to such tasks [ 7 , 8 ]. Consequently, pharmacists are the healthcare professionals in the ED dedicating most of their time to medication-related tasks.…”

“…Three researchers (M.F., T.J. and R.V.H.) had previously developed observation categories and adapted the WOMBAT tool to the study settings by shadowing and interviewing physicians and nurses in the EDs [ 7 , 8 ]. They identified and defined the work tasks, locations, interactions and tools involved, which finally resulted in 53 mutually exclusive categories of interest, for which inter-rater validation was performed [ 7 , 8 ].…”

“…had previously developed observation categories and adapted the WOMBAT tool to the study settings by shadowing and interviewing physicians and nurses in the EDs [ 7 , 8 ]. They identified and defined the work tasks, locations, interactions and tools involved, which finally resulted in 53 mutually exclusive categories of interest, for which inter-rater validation was performed [ 7 , 8 ]. The current study’s observer (S.A.) interviewed and shadowed the ED pharmacists after they had been working in the EDs for some months and adjusted the WOMBAT categories for ED pharmacists.…”

“…The standard ED healthcare personnel, physicians and nurses, are frequently overwhelmed by their high workload and critical patient care and so tend to prioritize other clinical tasks over purely medication-related tasks [ 5 ]. Both physicians and nurses spend the majority of their time on non-medication-related tasks [ 6 , 7 , 8 ]. Physicians, who are the main personnel responsible for patient safety, experience that MedRec and MedRev are time consuming and that medication-related tasks represent a cognitive burden [ 5 ].…”