Critical Care Explorations (Apr 2021)

PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study

  • Megan A. Rech, PharmD, MS, FCCM,
  • William Adams, PhD,
  • Keaton S. Smetana, PharmD,
  • Payal K. Gurnani, PharmD, FCCM,
  • Megan A. Van Berkel Patel, PharmD,
  • William J. Peppard, PharmD, FCCM,
  • Drayton A. Hammond, PharmD, MBA, MSc,
  • Alexander H. Flannery, PharmD, FCCM,
  • PHARM-EM Investigators,
  • on behalf of the Society of Critical Care Medicine Clinical Pharmacy and Pharmacology Section and endorsed by the Discovery Network,
  • Giles Slocum,
  • Josh DeMott,
  • Michelle Malatlian,
  • Kathryn Samai,
  • Rachel Lazim,
  • Kyle Allmond,
  • Abby Bussey,
  • Patrick Blankenship,
  • Joanne Routsolias,
  • Arnett Alyson Basting,
  • Rebecca Finder,
  • Holly Nuest,
  • Hillcrest Elizabeth Adams,
  • Kerri Federico,
  • William Snow,
  • Tina Liu,
  • Derex Louie,
  • Audra DeChristopher,
  • Nadine Faulkner,
  • Mallory Cruz,
  • Yelena Figuerado,
  • Adrienne Kercsak,
  • Thomas Gregory,
  • Lamanh Le,
  • Tim Molinarolo,
  • Alicia Zu Wallack,
  • Kaitlyn Caswell,
  • Dina Nakhleh,
  • Cait Pfaff,
  • Mary Hormese,
  • Marc McDowell,
  • Ashley Martinelli,
  • Maggie Ma,
  • Tara Flack,
  • Matt McAllister,
  • Megan Webb,
  • Rachel Beham,
  • Alyssa Garner,
  • Logon Olson,
  • Terese Poon,
  • Ryan Balmat,
  • Celeste Wise,
  • Sean Hackett,
  • Frank Rigelsky,
  • Julia Kuroski,
  • Matthew Nagar,
  • Elise Metts,
  • Dina Ali,
  • Gavin Howington,
  • Jason Davis,
  • Nicole Acquisto,
  • Kaylee Maynard,
  • Mercy Hoang,
  • Faisal Minhaj,
  • Keith Kalvaitis,
  • Michele Handzel,
  • Kate Kokanovich,
  • Caitlin Fronhapple,
  • Marin Valentino,
  • Jessica Kozakiewicz,
  • Chara Calhoun,
  • Kyle Weant,
  • Lisa Hall Zimmerman,
  • Kris Thomassian,
  • Brett Faine,
  • Stacey Rewitzer,
  • Anne Zepeski,
  • Zach Smith,
  • Christele Francois,
  • Brandon Huang,
  • Cody Null,
  • Jessica Glas,
  • Brian Gilbert,
  • Caitlin Brown,
  • Francis Manuel,
  • Toledo William Kirsch,
  • Kristen Thomas,
  • Curtis Geier,
  • Jessica Rivera,
  • Neil Umstead,
  • John Pitts,
  • Jerry Lepore,
  • Bob Piavis,
  • Giang Duong,
  • Matthew Ford,
  • Katrina Karpowitsch

DOI
https://doi.org/10.1097/CCE.0000000000000406
Journal volume & issue
Vol. 3, no. 4
p. e0406

Abstract

Read online

Objectives:. To comprehensively classify interventions performed by emergency medicine clinical pharmacists and quantify cost avoidance generated through their accepted interventions. Design:. A multicenter, prospective, observational study was performed between August 2018 and January 2019. Setting:. Community and academic hospitals in the United States. Participants:. Emergency medicine clinical pharmacists. Interventions:. Recommendations classified into one of 38 intervention categories associated with cost avoidance. Measurements and Main Results:. Eighty-eight emergency medicine pharmacists at 49 centers performed 13,984 interventions during 917 shifts that were accepted on 8,602 patients and generated $7,531,862 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established categories were as follows: adverse drug event prevention (1,631 interventions; $2,225,049 cost avoidance), resource utilization (628; $310,582), individualization of patient care (6,122; $1,787,170), prophylaxis (24; $22,804), hands-on care (3,533; $2,836,811), and administrative/supportive tasks (2,046; $342,881). Mean cost avoidance was $538.61 per intervention, $875.60 per patient, and $8,213.59 per emergency medicine pharmacist shift. The annualized cost avoidance from an emergency medicine pharmacist was $1,971,262. The monetary cost avoidance to pharmacist salary ratio was between $1.4:1 and $10.6:1. Conclusions:. Pharmacist involvement in the care of patients presenting to the emergency department results in significant avoidance of healthcare costs, particularly in the areas of hands-on care and adverse drug event prevention. The potential monetary benefit-to-cost ratio for emergency medicine pharmacists is between $1.4:1 and $10.6:1.