Background There are concerns about maintaining\nappropriate clinical staffing levels in Emergency\nDepartments. Pharmacists may be one possible solution.\nObjective To determine if Emergency Department attendees\ncould be clinically managed by pharmacists with or\nwithout advanced clinical practice training. Setting\nProspective 49 site cross-sectional observational study of\npatients attending Emergency Departments in England.\nMethod Pharmacist data collectors identified patient\nattendance at their Emergency Department, recorded\nanonymized details of 400 cases and categorized each into\none of four possible options: cases which could be managed\nby a community pharmacist; could be managed by a\nhospital pharmacist independent prescriber; could be\nmanaged by a hospital pharmacist independent prescriber\nwith additional clinical training; or medical team only\n(unsuitable for pharmacists to manage). Impact indices\nsensitive to both workload and proportion of pharmacist\nmanageable cases were calculated for each clinical group.\nMain outcome measure Proportion of cases which could be\nmanaged by a pharmacist. Results 18,613 cases were\nobserved from 49 sites. 726 (3.9%) of cases were judged\nsuitable for clinical management by community pharmacists,\n719 (3.9%) by pharmacist prescribers, 5202 (27.9%)\nby pharmacist prescribers with further training, and 11,966\n(64.3%) for medical team only. Impact Indices of the most\nfrequent clinical groupings were general medicine (13.18)\nand orthopaedics (9.69). Conclusion The proportion of\nEmergency Department cases that could potentially be\nmanaged by a pharmacist was 36%. Greatest potential for\npharmacist management was in general medicine and\northopaedics (usually minor trauma). Findings support the\ncase for extending the clinical role of pharmacists.
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