Impact of automated dispensing cabinets on medication administration efficiency in the emergency department.

BACKGROUND: Timely medication administration in emergency departments (EDs) is essential for optimal patient outcomes. Automated Dispensing Cabinets (ADCs) may improve point-of-care medication access, yet their impact on administration timeliness is uncertain in ED settings. OBJECTIVE: To evaluate the association between ADC implementation and the timeliness of stat medication administration in a high-volume ED in Taiwan. METHODS: We conducted a retrospective observational study analyzing 16,450 adult ED visits from July-August 2019 (pre-ADC) and July-August 2020 (post-ADC). Order-to-administration (OTA) times for stat medications were compared. Multivariable logistic and linear regression analyses evaluated the association between ADC implementation and timely medication delivery. Sensitivity analyses, including a difference-in-differences model and survival analysis using Kaplan-Meier curves and multivariable Cox regression, were performed to evaluate the robustness of findings. RESULTS: After adjusting for potential confounders, ADC implementation was independently associated with higher odds of achieving OTA times ≤ 30 min (adjusted odds ratio aOR, 1.59; 95% confidence interval CI, 1.42-1.78). Linear regression showed a mean reduction in OTA time of 3.09 min per prescription (β = - 3.09; 95% CI, - 3.58 to - 2.60). Subgroup analyses showed that ADC implementation was associated with higher odds of achieving OTA ≤ 30 min and shorter OTA times for antibiotics (aOR, 2.19; 95% CI, 1.54-3.12; β = - 4.99; 95% CI, - 7.03 to - 2.94), as well as during daytime (aOR, 1.87; 95% CI, 1.58-2.21; β = - 4.34; 95% CI, - 5.26 to - 3.41) and weekend shifts (aOR, 1.66; 95% CI, 1.34-2.05; β = - 3.48; 95% CI, - 4.30 to - 2.65). Findings from sensitivity analyses were consistent with the primary results. CONCLUSION: ADC implementation In the ED was associated with modest but operationally meaningful improvements in medication administration timeliness. These findings may be context-dependent and warrant confirmation across diverse workflows and with patient-centered and safety outcomes. CLINICAL TRIAL NUMBER: Not applicable.