Perhaps it’s workflow, perhaps it’s culture, perhaps it’s just the nature of the setting, but physician assistants and nurse practitioners have been e-prescribing at a higher rate than physicians in the emergency department of one major pediatric hospital.
In a poster presented at the American Medical Informatics Association annual symposium in San Francisco, researchers at Children’s National Health System in Washington, D.C., found that physicians in the ED e-prescribed 31 percent of the time, far less than the 42 percent rate among nonphysician prescribers.
Specifically, nurse practitioners had an e-prescribing rate of 38.6 percent during the study period, December 2013 to October 2014, while physician assistants wrote electronic prescriptions 46.2 of the time. That compares to 41.1 percent for attending pediatric emergency physicians with five or more years of experience, 30.6 for attendings with less experience, 29.5 percent for fellows and 26.3 percent for other pediatricians in the ED. The researchers excluded medical residents from the study.
Lead poster author Dr. Mordechai Raskas, a fellow in pediatric emergency medicine at the hospital, attributed the difference to several factors, one of which seems to have been an oversight.
When e-prescribing, practitioners have to ask patients or their families what pharmacy they want the prescriptions sent to, a step that’s not necessary with paper scripts. “No one accounted for the workflow change,” Raskas said Tuesday.
Also, NPs and PAs tend to devote more time to each patient in the ED, according to Raskas, so they are more likely to take the time to ask the question. “Physicians have to care for entire pods of patients” in the Children’s National ED, Raskas said.
E-prescribing is supposed to be faster than the traditional paper method — sometimes just a click or two for refills — but by nature, there aren’t many refills written in emergency environments. Plus, in the absence of fully functional health information exchange, prescribers don’t always have complete patient histories in front of them in the ED.
A Deep-dive Into Specialty Pharma
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Raskas and his colleagues also found that the e-prescribing rate was higher during daytime shifts and on Tuesdays. “Tuesday is the lowest-volume day in the ED,” he said.
A Walgreens pharmacy opened in the hospital building last year, Raskas said, but it closes at 9 p.m. on weekdays and 6 p.m. on weekends. The convenience might account for the higher daytime e-prescribing rate.
Photo: Flickr user Jeff Kramer
