TOPLINE

Pharmacist interventions on medication orders increased as emergency department (ED) clinicians progressed through their shifts, with the likelihood of intervention rising by approximately 4% for each additional hour worked.

METHODOLOGY

• Researchers conducted an observational study of 622,171 medication orders placed by 308 clinicians in two academic EDs between January 2022 and November 2023.
• The analysis included medication orders from 182,894 unique patient encounters at an urban academic ED with 109,000 annual visits (site A) and a suburban academic trauma center with 88,000 annual visits (site B).
• The primary outcome was a pharmacist intervention on a medication order, and the primary exposure was the time spent on shift by clinicians.

TAKEAWAY

• Overall, 9054 orders were associated with a pharmacy intervention. Pharmacist intervention rates increased as clinicians progressed through their shifts, rising by 4% for each additional hour worked (odds ratio [OR], 1.04; 95% CI, 1.03-1.05).
• The association between the time spent on shift by clinicians and pharmacist intervention rates remained positive across attending physicians (OR, 1.05; 95% CI, 1.03-1.07), residents (OR, 1.03; 95% CI, 1.01-1.05), and physician assistants (OR, 1.05; 95% CI, 1.04-1.06).
• Pharmacist intervention rates increased with the time spent on shift by clinicians during both overnight shifts (OR, 1.04; 95% CI, 1.02-1.06) and daytime shifts (OR, 1.04; 95% CI, 1.03-1.05). The association between the time spent on shift and pharmacy interventions was positive for site A (OR, 1.05; 95% CI, 1.04-1.06) but not for site B (OR, 1.01; 95% CI, 0.98-1.04).
• Intervention rates were highest for anticoagulants (7.8%), followed by antibiotics (6.8%), diuretics (2.4%), and antihyperglycemics (2.3%).

IN PRACTICE

"The results of this study demonstrate that pharmacist interventions increase with emergency medicine clinician time on shift, suggesting the presence of decision fatigue, physical fatigue, and/or other accumulative impairments in clinical practice during the shift," the authors wrote.

SOURCE

The study was led by Stephen Fatuzzo, NYU Grossman School of Medicine in New York City. It was published online on June 12, 2026, in Annals of Emergency Medicine.

LIMITATIONS

The study was retrospective and conducted within a single health system. Researchers did not account for differences in clinician experience or patient complexity and used pharmacist interventions as a proxy measure of decision fatigue. Additionally, not all pharmacist interventions necessarily reflected medication-ordering errors.

DISCLOSURES

The authors reported receiving no funding for this study. Two authors reported receiving support from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute on Aging outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.