Clinical pharmacy workload in medical and surgical patients: Effect of patient partition, disease complexity and Major Disease Category

Objectives The aim of this study was to measure the time spent providing clinical pharmacy services to individual patient episodes for general medical and surgical patients and to measure the effect of patient presentation and complexity on this workload. Methods We conducted a 5-month study at The Northern Hospital and Western Hospital in Melbourne, Australia, during 2006. Pharmacists recorded a defined range of activities that they provided for individual patients, including the actual times required for these tasks. A customised database, linked to the two hospitals' patient administration systems, stored these data according to the specific patient episode number. We then examined the influence of patient presentation and complexity on clinical pharmacy activities provided. Key findings During intervals when pharmacists recorded the time required to conduct activities, the average time required to perform the medication history and reconciliation exercise on 3052 occasions was 9.6 ± 4.5 min. The 1844 interventions required an average of 5.9 ± 3.0 min, clinical review of the patient's medical record required 5.5 ± 2.7 min and medication order review required 3.5 ± 1.3 min. For all of these activities, the time required was greater for medical patients than for surgical patients and greater for patients whose Diagnosis Related Group classification included a complication or co-morbidity. The average time required to perform all clinical pharmacy activities for 4625 completed patient episodes was 22.4 ± 16.7 min and was again greater for medical patients and for patients with a complication or co-morbidity. Conclusions The times required to perform a range of clinical pharmacy activities for individual patients was affected by whether the patients were medical or surgical patients. Furthermore, the existence of co-morbidities or complications affected these times. The methodology has potential application for other patient presentations and in other practice settings.