Department of Clinical Pharmacy, Nîmes University Hospital, Nîmes, France.
Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, Montpellier University, Montpellier, France.
Crit Care Med. 2018 Feb;46(2):199-207. doi: 10.1097/CCM.0000000000002827.
Surgical and medical ICU patients are at high risk of mortality and provide a significant cost to the healthcare system. The aim of this study is to describe the effect of pharmacist-led interventions on drug therapy and clinical strategies on ICU patient outcome and hospital costs.
Before and after study in two French ICUs (16 and 10 beds).
ICU patients.
From January 1, 2013, to June 30, 2015, a pharmacist observation period was compared with an intervention period in which a critical care pharmacist provided recommendations to clinicians regarding sedative drugs and doses, choice of mechanical ventilation mode and related settings, antimicrobial de-escalation, and central venous and urinary catheters removal. Differences in ICU and hospital length of stay, duration of mechanical ventilation, mortality rate, and hospital costs per patient were quantified between groups with patients matched for severity of illness (Simplified Acute Physiology Score II) at admission.
From the 1,519 and 1,268 admitted patients during the observation and intervention periods, respectively, 1,164 patients were evaluable in both groups after matching for Simplified Acute Physiology Score II score. The intervention period was associated with mean (95% CI) reductions in patient hospital length of stay (3.7 d [5.2-2.3 d]; p < 0.001), ICU length of stay (1.4 d [2.3-0.5 d]; p < 0.005), duration of mechanical ventilation (1.2 d [2.1-0.3 d]; p < 0.01), and hospital costs per stay (2,560 euros [3,728-1,392 euros]; p < 0.001). The overall cost savings were 10,840 euros (10,727-10,952 euros) per month, mostly due to reduced consumption of sedatives and antimicrobials. No impact on mortality rate was identified.
Critical care pharmacist-led interventions were associated with decreases in ICU and hospital length of stays and ICU drug costs.
外科和内科重症监护病房（ICU）患者的死亡率较高，给医疗保健系统带来了巨大的成本。本研究旨在描述药剂师主导的干预措施对 ICU 患者结局和医院成本的药物治疗和临床策略的影响。
在法国的两个 ICU（16 张床和 10 张床）进行了前后研究。
ICU 患者。
从 2013 年 1 月 1 日至 2015 年 6 月 30 日，比较了药剂师观察期和干预期，在此期间，一名重症监护药剂师向临床医生提供了镇静药物和剂量、机械通气模式和相关设置、抗菌药物降阶梯、中心静脉和导尿管去除的建议。通过对入院时疾病严重程度（简化急性生理学评分 II）相匹配的患者，比较了两组 ICU 住院时间、机械通气时间、死亡率和每位患者的住院费用的差异。
在观察期和干预期分别收治的 1519 名和 1268 名患者中，1164 名患者在简化急性生理学评分 II 评分相匹配后可在两组中进行评估。干预期与患者住院时间（3.7 天[5.2-2.3 天]；p<0.001）、ICU 住院时间（1.4 天[2.3-0.5 天]；p<0.005）、机械通气时间（1.2 天[2.1-0.3 天]；p<0.01）和住院费用（2560 欧元[3728-1392 欧元]；p<0.001）的平均（95%CI）减少相关。每月总体节省成本为 10840 欧元（10727-10952 欧元），主要归因于镇静剂和抗菌药物消耗量的减少。死亡率没有明显变化。
重症监护药剂师主导的干预措施与 ICU 和医院住院时间以及 ICU 药物成本的减少相关。
