Department of Pharmacy, Intermountain Medical Center, Intermountain Health, Salt Lake City, UT, United States of America.
Department of Pharmacy, Intermountain Medical Center, Intermountain Health, Salt Lake City, UT, United States of America.
Am J Emerg Med. 2024 Aug;82:63-67. doi: 10.1016/j.ajem.2024.05.011. Epub 2024 May 9.
To investigate the cost-avoidance associated with implementation of an overnight emergency medicine pharmacist (EMP) through documented clinical interventions.
Retrospective evaluation of prospectively tracked interventions in a single Level I Trauma, Comprehensive Stroke Center, from November 25, 2020 through March 12, 2021 during expanded emergency medicine service hours (2300-0700).
One of 45 clinical patient-care recommendations associated with cost-avoidance were available to be selected and documented by the EMP; more than one intervention was allowed per patient, though one clinical intervention could not be counted as multiple items. Documented services were associated with monetary cost avoidance based upon available literature assessing pharmacy clinical interventions. Differences in time from imaging to systemic thrombolytics and percentage of patients meeting door-to-alteplase benchmarks were compared with and without the availability of EMPs.
Overnight EMPs documented 820 interventions during 107 overnight shifts with a cost avoidance of $612,974. The most common interventions were bedside monitoring (n = 127; $50,694), drug information consultation (97; $11,269), and antimicrobial therapy initiation and streamlining (95; $60,101). When categorizing interventions, 378 (46%; $292,484) were input as hands-on care, 216 (26%; $94,899) as individualization of patient care, 135 (17%; $25,897) as administrative and supportive tasks, 84 (10%; $121,746) as adverse drug event prevention, and 7 (1%; $77,964) as resource utilization. All patients (n = 6) with an acute ischemic stroke during the evaluation period received systemic thrombolytics ≤45 min in the presence of EMPs compared with 50% receiving thrombolytics ≤45 min without EMPs.
Expanded overnight coverage by EMPs provided clinical bedside pharmacotherapy expertise to critically ill patients otherwise not available prior to study implementation. Clinical interventions were associated with substantial cost-avoidance.
通过记录的临床干预措施，调查实施夜间急诊药师（EMP）所带来的成本节约。
对 2020 年 11 月 25 日至 2021 年 3 月 12 日期间，在扩大急诊服务时间（23:00-07:00）期间，在单一的一级创伤综合卒中中心进行的前瞻性跟踪干预的回顾性评估。
45 项与成本节约相关的临床患者护理建议中的一项可供 EMP 选择和记录；每位患者允许使用多项干预措施，但一项临床干预措施不能算作多项。根据评估药学临床干预的现有文献，记录的服务与货币成本节约相关。比较了有和没有 EMP 时，从影像学检查到全身溶栓治疗的时间差异，以及符合门到阿替普酶时间标准的患者比例。
夜间 EMP 在 107 个夜间班次中记录了 820 项干预措施，成本节约了 612974 美元。最常见的干预措施是床边监测（n=127；50694 美元）、药物信息咨询（97；11269 美元）和抗菌药物治疗的启动和简化（95；60101 美元）。当对干预措施进行分类时，378 项（46%；292484 美元）被归类为直接护理，216 项（26%；94899 美元）为患者护理的个体化，135 项（17%；25897 美元）为行政和支持任务，84 项（10%；121746 美元）为预防药物不良反应，7 项（1%；77964 美元）为资源利用。在评估期间，所有（n=6）患有急性缺血性脑卒中的患者在有 EMP 的情况下，在 45 分钟内接受了全身溶栓治疗，而没有 EMP 的情况下，只有 50%的患者在 45 分钟内接受了溶栓治疗。
在研究实施之前，夜间急诊药师（EMP）的扩大夜间覆盖为危重病患者提供了临床床边药物治疗专业知识，否则无法获得这些知识。临床干预措施与显著的成本节约相关。
