MacLaren Robert, Bond C A, Martin Steven J, Fike David
Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Denver, Aurora, CO, USA.
Crit Care Med. 2008 Dec;36(12):3184-9. doi: 10.1097/CCM.0b013e31818f2269.
To determine whether the absence or presence of clinical pharmacists in intensive care units (ICUs) results in differences in mortality rates, length of ICU stay, and ICU charges for Medicare patients with nosocomial-acquired infections, community-acquired infections, and sepsis.
DESIGN, SETTING, AND PATIENTS: The type and level of pharmacy services provided to ICUs were obtained from a 2004 national survey. Clinical pharmacy services were defined as having at least a partial pharmacist full-time equivalent specifically devoted to the ICU for the purpose of direct involvement in patient care. Infections were defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. ICU outcome data were drawn from the 2004 modified Medicare provider analysis and review. Depending on the infection studied, the involvement of clinical pharmacists was evaluated in 8,927-54,042 patients from 265 to 276 hospitals.
None.
Mortality rates, length of ICU stay, Medicare charges, drug charges, and laboratory charges for each of the infections categorized according to the absence or presence of clinical pharmacists. Compared to ICUs with clinical pharmacists, mortality rates in ICUs that did not have clinical pharmacists were higher by 23.6% (p < 0.001, 386 extra deaths), 16.2% (p = 0.008, 74 extra deaths), and 4.8% (p = 0.008, 211 extra deaths) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. Similarly, ICU length of stay was longer by 7.9% (p < 0.001, 14,248 extra days), 5.9% (p = 0.03, 2855 extra days), and 8.1% (p < 0.001, 19,215 extra days) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. ICUs that did not have clinical pharmacists had greater total Medicare billings of 12% (p < 0.001, $132,978,807 extra billing charges), 11.9% (p < 0.001, $32,240,378 extra billing charges), and 12.9% (p < 0.001, $224,694,784 extra billing charges) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. Similar findings were observed for Medicare drug charges and laboratory charges.
The involvement of clinical pharmacists in the care of critically ill Medicare patients with infections is associated with improved clinical and economic outcomes. Hospitals should consider employing clinical ICU pharmacists.
确定重症监护病房（ICU）中临床药师的有无是否会导致患有医院获得性感染、社区获得性感染和脓毒症的医疗保险患者在死亡率、ICU住院时间和ICU费用方面存在差异。
设计、地点和患者：从2004年全国调查中获取提供给ICU的药学服务类型和水平。临床药学服务定义为至少有一名全职等效药师专门负责ICU，以便直接参与患者护理。感染使用《国际疾病分类，第九版，临床修订本》编码进行定义。ICU结局数据来自2004年修订的医疗保险提供者分析与审查。根据所研究的感染情况，在265至276家医院的8927 - 54042名患者中评估临床药师的参与情况。
无。
根据临床药师的有无对每种感染的死亡率、ICU住院时间、医疗保险费用、药品费用和实验室费用进行评估。与配备临床药师的ICU相比，没有临床药师的ICU中医院获得性感染、社区获得性感染和脓毒症的死亡率分别高出23.6%（p < 0.001，多死亡386例）、16.2%（p = 0.008，多死亡74例）和4.8%（p = 0.008，多死亡211例）。同样，医院获得性感染、社区获得性感染和脓毒症的ICU住院时间分别长7.9%（p < 0.001，多14248天）、5.9%（p = 0.03，多2855天）和8.1%（p < 0.001，多19215天）。没有临床药师的ICU中医院获得性感染、社区获得性感染和脓毒症的医疗保险总费用分别高出12%（p < 0.001，额外计费132978807美元）、11.9%（p < 0.001，额外计费32240378美元）和12.9%（p < 0.001，额外计费224694784美元）。医疗保险药品费用和实验室费用也观察到类似结果。
临床药师参与感染的重症医疗保险患者护理与改善临床和经济结局相关。医院应考虑聘用临床ICU药师。
