Belcher Rachel M, Blair Anastasia, Chauv Stephanie, Hoang Quang, Hickman Abby W, Peng Melissa, Baldwin Margaret, Koch Logan, Nguyen Mark, Guidry David, Fontaine Gabriel V
Department of Pharmacy, Intermountain Healthcare, Murray, UT.
TeleHealth, TeleCritical Care, Intermountain Healthcare, Murray, UT.
Crit Care Explor. 2023 Jan 12;5(1):e0839. doi: 10.1097/CCE.0000000000000839. eCollection 2023 Jan.
Critical care pharmacists when incorporated into the ICU team, have been shown to improve outcomes in critically ill patients by decreasing mortality, improving morbidity and reducing cost. As telehealth continues to evolve, the incorporation of a critical care pharmacist into a comprehensive telecritical care (TCC) service will allow increased comprehensive pharmacotherapeutic care for those in smaller, community or rural hospitals.
To describe the implementation of a TCC pharmacist into an established TCC network, classify interventions performed, and quantify cost avoidance generated through pharmacist interventions.
Multicenter, observational cohort study and retrospective return on investment, performed between December 2019 and December 2021.
Critically ill adult patients, admitted to an ICU located in any of our eight community hospitals (50 ICU beds) within a large, 25-hospital integrated healthcare system (563 ICU beds total) in the United States.
The TCC pharmacist service was implemented in 8-hour shifts, initially available 5 days per week, then expanded to 7 days per week. Critical care pharmacist interventions were categorized by clinical type established utilizing American Society of Health-System Pharmacists benchmarking standards and the latest cost avoidance data.
During the 2-year analysis period, TCC pharmacists documented 2,838 interventions generating $1,664,254 of gross cost avoidance and a return on investment of 4.5:1.
It is feasible to implement a TCC pharmacist within an established TCC network. Our experience showed enhanced comprehensive care of critically ill patients located in community hospitals within a large, integrated healthcare system, demonstrated significant cost avoidance, and has led to other initiatives, including a collaborative clinical/operational partnership with Life Flight.
重症监护药师加入重症监护病房团队后，已证明可通过降低死亡率、改善发病率和降低成本来改善重症患者的治疗结果。随着远程医疗的不断发展，将重症监护药师纳入全面的远程重症监护（TCC）服务，将能够为规模较小的社区或农村医院的患者提供更多全面的药物治疗护理。
描述在已建立的TCC网络中实施TCC药师的情况，对所进行的干预措施进行分类，并量化药师干预所产生的成本节约。
2019年12月至2021年12月期间进行的多中心观察性队列研究和回顾性投资回报率分析。
在美国一个拥有25家医院的大型综合医疗系统（共563张重症监护病床）内，入住我们八家社区医院（50张重症监护病床）中任何一家重症监护病房的成年重症患者。
TCC药师服务按8小时轮班实施，最初每周提供5天，然后扩展到每周7天。重症监护药师的干预措施根据利用美国卫生系统药师协会基准标准和最新成本节约数据确定的临床类型进行分类。
在为期两年的分析期内，TCC药师记录了2838次干预措施，产生了1664254美元的总成本节约，投资回报率为4.5:1。
在已建立的TCC网络中实施TCC药师是可行的。我们的经验表明，在一个大型综合医疗系统内，对社区医院的重症患者提供了强化的综合护理，证明了显著的成本节约，并引发了其他举措，包括与空中医疗救援建立临床/运营合作关系。
