title: Slick scripts: impact on patient flow targets of pharmacists preparing discharge prescriptions in a hospital with an electronic prescribing system.
abstract: OBJECTIVE
  Inpatient bed access decreases when ward discharge is delayed. This contributes to prolonged emergency department (ED) length of stay (LOS) which has been associated with increased hospital LOS and mortality. Delays in preparation of discharge medication prescriptions by ward doctors may contribute to delayed ward discharge. This project aimed to evaluate the effect on patient flow of having a pharmacist collaborate with ward doctors to prepare discharge prescriptions at a hospital with an electronic prescribing system.
  
  
  METHODS
  Eight-week pre- and post-intervention study on two surgical wards at a major metropolitan Australian hospital. During the intervention, a project pharmacist (PP) electronically prepared discharge prescriptions, in consultation with ward doctors, which were reviewed by the regular ward pharmacist before being dispensed. Outcome measures, based on hospital performance indicators, included: Percentage of patients transferred to wards from ED within four and six hours of presentation; Median time (minutes) past 9 am that patients were discharged from the wards; Percentage of patients discharged from wards by 9 am; Staff satisfaction.
  
  
  RESULTS
  Pre- and post-intervention, there were 259 and 246 patients transferred from ED to the study wards, respectively. The percentage of patients transferred within four and six hours of presentation did not change. There were 320 and 341 patients discharged, pre- and post-intervention, respectively, who required a discharge prescription. The PP prepared 273 (80%) prescriptions during the post-intervention period. Patients were discharged 57 minutes earlier with the intervention (median 211 vs. 154 minutes past 9 am, P = 0.01). The percentage of patients discharged before 9 am increased from 6% to 12% (P = 0.01). All 26 health-professional respondents (79% response rate) were satisfied with the service and recommended its continuation.
  
  
  CONCLUSIONS
  Pharmacist collaboration with doctors to prepare discharge prescriptions did not impact upon ED access targets, but resulted in patients being discharged earlier.
authors.affiliation: Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia.|Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Tran
authors.affiliation: Orthopaedic Surgery, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hardidge
authors.affiliation: Surgical Clinical Service Unit, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Melodie
authors.initials: M
authors.lastname: Heland
authors.affiliation: Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Simone E
authors.initials: SE
authors.lastname: Taylor
authors.affiliation: Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Kent
authors.initials: K
authors.lastname: Garrett
authors.affiliation: Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Elise
authors.initials: E
authors.lastname: Mitri
authors.affiliation: Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia.|Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
authors.forename: Rohan A
authors.initials: RA
authors.lastname: Elliott
mesh_terms: D001315:Australia; D017598:Efficiency, Organizational; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000458:organization & administration / Q000706:statistics & numerical data; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D013997:Time Factors; D057188:Workflow
keywords: electronic prescribing; hospital emergency service; medication reconciliation; patient discharge; pharmacists; surgical units