Episode 154: One equation hospital pharmacists should use every day (and it’s not Cockcroft-Gault)

In this episode, I’ll discuss a formula I use to prioritize my daily activities.

1 minute before 9 am = 2 minutes after noon

Several years ago I read the copy of The Hospitalists Manual that my medical librarian had ordered. In the chapter titled “Pacing and Efficiency: The Way of the Hospitalist” this simple formula stood out to me:

Every minute before 9 am is worth two after mid-day.

 

The authors of The Hospitalist Manual talk about this formula in the context of completing rounds and writing notes and orders before the middle of the day. They point out that completing this necessary work early would free up time later in the day to spend on unexpected events or important follow-up care.

For some reason, that formula and concept resonated with me, and I began to apply it to my day as a hospital pharmacist.

Instead of hospitalist tasks like writing orders, examining patients, and new admissions, I have pre-rounding, monitoring, and report reviewing to do in the morning. I began to be mindful of doing these essential tasks as the absolute first thing in the morning, with the goal of getting them done before 9 am. And by ‘absolute first thing in the morning’ I mean: work on these things before answering emails, updating policies or protocols, completing a medication use evaluation, or chatting at the water cooler.

After I started using this formula to guide my start to the day, four important things happened to me:

1. My day became more efficient. Early in the morning, charts and patients tend to be on the unit for easy access rather than off the unit for a test or procedure. I spend less time hunting down charts or returning to the unit to interview a patient because they were off the unit the first time I checked.
2. Much of my work-related stress disappeared. Because essential tasks are out of the way before the day is halfway done, I am rarely scrambling at the end of the day to finish that last patient consult or follow-up.
3. Tremendous opportunities opened up for me to expand my knowledge base and learn from other clinicians. With the essential tasks out of the way I can say ‘yes’ to questions like “Do you want to watch this autopsy?” or “Do you want to see the bronchoscopy?” I can respond to every rapid response or code blue call without leaving an essential task undone. I have the time to hunt down a consultant like a cardiologist or infectious disease doctor and learn something new from them.
4. Unexpected events are no longer a problem. Surprise meeting with the boss? No problem, my pre-rounding is already done. A resident needs a mentor? No problem, my consults are already done. Three patients decide to have back-to-back-to-back code blues? No problem, I’ve got the time.

Every once in a while, I will end up starting my day with some non-essential task like email or protocol development, and it never fails to be a hectic day. That is just a teachable moment where I can explain to a student or resident how 1 minute before 9 am = 2 minutes after noon.

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If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.

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