Tip of the Week: Adding Value in Acute Care Settings
This week’s tip examines a comprehensive set of pharmacist-based interventions in acute care settings.
Pharmacists must demonstrate the value of their services. This is true anywhere, but in hospitals it might be especially the case given that the pharmacy is viewed as a cost center with high inventory and labor in prospective payment systems based on diagnostic—related groups (DRGs).
Under DRGs, length of stay (LOS) becomes a very important outcome. The hospital, while at once balancing the need to prevent frequent readmissions, still needs to minimize LOS for patients, particularly when extended LOS is caused by inefficient or ineffective care.
Leary et al evaluated the impact of pharmacist-driven interventions on LOS in acute care. They employed a pre-post design to compare the effect of pharmacist interventions across 3 practice areas: hematology/oncology, medicine, and pediatrics. The interventions included detailed chart review, prescriber consultations, and targeted pre-discharge services, such as discharge prescription writing (with provider co-signature).
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The analysis included 924 patients, including 466 pre- and 458 post-analysis. The median LOS decreased from 4.95 to 4.12 days in the pre and post groups, respectively. There was no difference in readmission rates between groups.
Interviews with participating pharmacists revealed several themes, including a positive impact on professional development, and increased relevance for participating in positive patient outcomes, and in interdisciplinary care. The study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists' responsibilities.
The average reduction in LOS of nearly 1 day saves several thousand dollars for the hospital for each patient. Multiplied hundreds of times over, this produces extraordinary savings.
Pharmacy managers can integrate their staff pharmacists into a range of activities that demonstrate value to hospital leadership and advance the case for pharmacy if the manager approaches these situations from the proper perspective. If executed properly, this also promotes job satisfaction among the participating pharmacists.
Additional information about medication therapy management and management functions can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. You or your institution can subscribe to AccessPharmacy to access the textbook.
Shane P. Desselle, RPh, PhD, FAPhA, is Professor of Social/Behavioral Pharmacy at Touro University California. He is author of Chapter 1: The “Management” in Medication Therapy Management and Management Functions in the textbook Pharmacy Management: Essentials for All Practice Settings, 5e.
Leary MH, Morbitzer K, Walston BJ, et al. Evaluation of targeted pharmacist interventions to reduce length of stay in an acute care practice model. Ann Pharmacother. 2019;53(5):471-477.