Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of prescribing safety in primary care.
Medication use is a critical aspect of patient safety in outpatient settings. This direct observation and interview study examined how eight practices in the United Kingdom responded to patient requests for either new medications or medication refills outside of physician visits. Researchers looked at how the practices chose to trade off between speed of response (using nonphysicians to address requests) and thoroughness (having physicians review and approve requests). The interview participants noted hazards related to lack of physician review, such as prescribing an unsafe medication, and risks associated with delayed receipt of needed medications due to inefficiency. Practices with a larger number of requests and high physician workload, who cared for older and socioeconomically disadvantaged populations, were more likely to emphasize efficiency over thoroughness. Such emphasis may introduce additional prescribing safety concerns in a population already at significant risk for adverse drug events.