Fisher Arielle M, Ding Michael Q, Hochheiser Harry, Douglas Gerald P
Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA.
BMC Health Serv Res. 2016 Sep 29;16(1):529. doi: 10.1186/s12913-016-1787-6.
Free and charitable clinics are a critical part of America's healthcare safety net. Although informatics tools have the potential to mitigate many of the organizational and service-related challenges facing these clinics, little research attention has been paid to the workflows and potential impact of electronic systems in these settings. In previous work, we performed a qualitative investigation at a free clinic dispensary to identify workflow challenges that may be alleviated through introduction of informatics interventions. However, this earlier study did not quantify the magnitude of these challenges. Time-motion studies offer a precise standard in quantifying healthcare workers' time expenditures on clinical activities, and can provide valuable insight into system specifications. These data, informed by a lean healthcare perspective, provide a quality improvement framework intended to maximize value and eliminate waste in inefficient workflow processes.
We performed a continuous observation time-motion study in the Birmingham Free Clinic dispensary. Two researchers followed pharmacists over the course of three general clinic sessions and recorded the duration of specific tasks. Pharmacists were then asked to identify tasks as value-added or non-value-added to facilitate calculation of the value quotient, a metric used to determine a workflow's level of efficiency.
Four high-level workflow categories occupied almost 95 % of pharmacist time: prescription (Rx) preparation (39.8 %), clinician interaction (21.5 %), EMR operations (14.8 %), and patient interaction (18.7 %). Pharmacists invested the largest portion of time in prescription preparation, with 21.8 % of pharmacist time spent handwriting medication labels. Based on value categorizations made by the pharmacists, the average value quotient was found to be 40.3 %, indicating that pharmacists spend more than half of their time completing tasks they consider to be non-value-added.
Our results show that pharmacists spend a large portion of their time preparing prescriptions, primarily the handwritten labeling of medication bottles and documentation tasks, which is not an optimal utilization of pharmacist expertise. The value quotient further supports that there are many wasteful tasks that may benefit from workflow redesign and health information technology, which could result in efficiency improvements for pharmacists.
免费慈善诊所是美国医疗安全网的重要组成部分。尽管信息学工具有可能缓解这些诊所面临的许多组织和服务相关挑战，但很少有研究关注电子系统在这些环境中的工作流程和潜在影响。在之前的工作中，我们在一家免费诊所药房进行了定性调查，以确定通过引入信息学干预措施可能缓解的工作流程挑战。然而，这项早期研究并未对这些挑战的严重程度进行量化。时间动作研究为量化医护人员在临床活动上的时间支出提供了精确标准，并能为系统规范提供有价值的见解。这些基于精益医疗视角的数据提供了一个质量改进框架，旨在最大化价值并消除低效工作流程中的浪费。
我们在伯明翰免费诊所药房进行了一项连续观察时间动作研究。两名研究人员在三个普通门诊时段跟踪药剂师，并记录特定任务的持续时间。然后要求药剂师将任务识别为增值或非增值，以方便计算价值商数，这是一个用于确定工作流程效率水平的指标。
四个高层次工作流程类别几乎占据了药剂师95%的时间：处方准备（39.8%）、与临床医生互动（21.5%）、电子病历操作（14.8%）和与患者互动（18.7%）。药剂师将大部分时间投入到处方准备中，其中21.8%的药剂师时间用于手写药品标签。根据药剂师的价值分类，发现平均价值商数为40.3%，这表明药剂师花费超过一半时间完成他们认为是非增值的任务。
我们的结果表明，药剂师将大量时间用于准备处方，主要是手写药瓶标签和文档任务，这并非对药剂师专业知识的最佳利用。价值商数进一步支持，许多浪费性任务可能受益于工作流程重新设计和健康信息技术，这可能提高药剂师的工作效率。
