Future enhanced clinical role of pharmacists in Emergency Departments in England: multi-site observational evaluation

Elizabeth Hughes,Louis Mazard,Hirminder Ubhi,Matthew Aiello,David Terry,Chi Huynh,Keith Wilson,Konstantinos Petridis,Alex Terry,Anthony Sinclair

doi:10.1007/s11096-017-0497-4

Abstract

Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.

Highlights

To enable pharmacists to best support the clinical workload of Emergency Departments (ED) further advanced clinical practice training should focus on these two clinical areas, and if achieved would enable Advanced Clinical Practitioner Pharmacists (ACP-Pharmacists) to manage 27% of all ED attendees
Primary categorization of 18,613 ED cases confirms the potential for pharmacists to clinically manage up to 36% of ED attendees
Further training aligned to the Advanced Clinical Practice training pathway (IPTs—Advanced Clinical Practice Pharmacists) increases the potential of pharmacists to manage a further 28% of cases

Summary

Introduction

There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. At present there are concerns about maintaining appropriate clinical staffing levels in Emergency Departments (ED) in England [1] and in other countries [2, 3]. One possible solution is the extension of clinical activity performed by non-medical staff—including pharmacists [4]. Subsidiary clinical management of ED attendees may support patient through-put, relieve pressure on medical staff and reduce costs. Publications concerning pharmacists working within ED are usually focused on drug management, their role in ‘Rapid Response Teams’ or their role in Medical Admission Units, the usual admission route following ED [6, 7].

Methods

Findings

Discussion

Conclusion