Clinical and economic impact of medication reconciliation by designated ward pharmacists in a hospitalist-managed acute medical unit

https://doi.org/10.1016/j.sapharm.2021.06.005Get rights and content
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Highlights

  • We assessed the effect of a hospitalist-pharmacist collaborative system.

  • It involved the medication reconciliation service by ward designated pharmacists in a hospitalist-managed acute medical unit.

  • This contributed to reducing readmission rates and shortening hospital stays.

  • Patient-centered communication between the hospitalists and pharmacists can be promoted by a shared EMR channel.

Abstract

Background

Minimizing unintended medication errors after admission is a common goal for clinical pharmacists and hospitalists.

Objective

We assessed the clinical and economic impact of a medication reconciliation service in a model of designated ward pharmacists working in a hospitalist-managed acute medical unit as part of a multidisciplinary team.

Methods

In this retrospective observational study, we compared pharmacist intervention records before and after the implementation of a medication reconciliation service by designated pharmacists. The frequency and type of intervention were assessed and their clinical impact was estimated according to the length of hospital stay and 30-day readmission rate. A cost analysis was performed using the average hourly salary of a pharmacist, cost of interventions (time spent on interventions), and cost avoidance (avoided costs generated by interventions).

Results

After the implementation of the medication reconciliation service, the frequency of pharmacist interventions increased from 3.9% to 22.1% (p < 0.001). Intervention types were also more diverse than those before the implementation. The most common interventions included identifying medication discrepancies between pre-admission and hospitalization (22.7%) and potentially inappropriate medication use in the elderly (13.1%). The median length of hospital stay decreased from 9.6 to 8.9 days (p = 0.024); the 30-day readmission rate declined significantly from 7.8% to 4.8% (p = 0.046). Over two-thirds of interventions accepted by hospitalists were considered clinically significant or greater in severity. The cost difference between avoided cost and cost of interventions was 9838.58 USD in total or 1967.72 USD per month.

Conclusions

The implementation of a designated pharmacist-led medication reconciliation service had a positive clinical and economic impact in our hospitalist unit.

Keywords

Hospital medicine
Medication reconciliation
Care transitions
Clinical effectiveness
Cost analysis
Patient care team

Abbreviations

EMR
electronic medical record
MR tab
medication reconciliation tab
SNUBH
Seoul National University Bundang Hospital

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