Incorporating a Pharmacist into the Discharge Process: A Unit-Based Transitions of Care Pilot

Abstract

To evaluate the impact of a multifaceted, pharmacy-driven, unit-based transitions of care (TOC) program on all-cause 30-day readmission rates and to assess readmission rates in predefined subgroup patient populations. This prospective study included adult patients who were discharged from the pilot unit from January 5 to January 30, 2015. Patients who expired during hospitalization, left the hospital against medical advice, or transferred to another unit or nonaffiliated hospital were excluded. Possible pharmacist interventions included daily medication profile review, delivery of discharge medications to the bedside, counseling, and communication of a discharge medication list to follow-up providers. Patients had a 30-day follow-up period from the date of discharge to assess for readmission. A total of 131 patients were screened and 94 patients were included. The primary outcome evaluating 30-day readmission rates occurred in 12.8% of patients in the pilot group versus 18.8% of patients in the historical control group ( = .26). None of the patients who received all possible pharmacist interventions were readmitted. Secondary outcomes assessing readmission rates in predefined subgroup populations as well as length of stay were comparable between the 2 groups. All identified medication discrepancies were resolved prior to discharge. Readmission rates during the pilot were numerically lower but not statistically significant when compared with historical data. Enhancement of the pharmacy-driven TOC services through allocation of additional resources is in progress. Further investigation is warranted to determine the impact of a TOC pharmacist after the service is sustained.

Meds‐to‐Beds: The impact of a bedside medication delivery program on 30‐day readmissions

“…We found that bedside discharge medication delivery along with medication counseling led to a drastic reduction in unplanned 30‐day readmissions as compared with patients who did not receive such services. Previous pharmacy‐led transitions of care programs have addressed access to medications in their intervention by way of confirming insurance coverage and resolving barriers to medication access, but only three studies detailed delivery of discharge medications to a general medical‐surgical patient population while in the hospital . Of these three studies, one was limited to just 26% of the intervention group receiving bedside delivery …”

“…Meta‐analyses have shown that the involvement of a pharmacist in the TOC process decreases 30‐day readmission rates by as much as 30%, and pharmacist‐led TOC programs can decrease 30‐day readmission rates by 20% . As briefly described above, most pharmacist‐led and pharmacist‐involved TOC programs are multidisciplinary and multifactorial, and there remains a paucity of published research which specifically examines the implementation and impact of a pharmacist‐led medication bedside delivery program on hospital readmission rates . The Kern Medical Meds‐to‐Beds (MtB) program was established in September 2016 with the goal of decreasing 30‐day readmission rates by delivering discharge medications and pharmacist counseling at the patients' bedside.…”

Quality measures of clinical pharmacy services during transitions of care

“…81 Other studies have only found reduced rates in patients with moderate-to high-risk disease identified by medication classes or admission diagnoses. 77,81,82 Studies with no significant reductions in 30-day HCU rates in any population have included small sample sizes or very narrow patient populations (eg, cardiac or pulmonary diagnoses only). 22,28,54,[83][84][85][86][87][88] Overall, adequate study power determination for general or targeted populations should limit the number of studies with nonsignificant results.…”

“…For example, one study using a literacy‐sensitive intervention only found improvement in a subgroup with inadequate health literacy 81 . Other studies have only found reduced rates in patients with moderate‐ to high‐risk disease identified by medication classes or admission diagnoses 77,81,82 . Studies with no significant reductions in 30‐day HCU rates in any population have included small sample sizes or very narrow patient populations (eg, cardiac or pulmonary diagnoses only) 22,28,54,83‐88 …”

Expanding Pharmacy Services With an Intern Program at an Academic Medical Center

“…1 Organizations that implemented pharmacy services to provide patient education about medications have demonstrated a reduction in hospital readmissions and improved patient experience. 2,3 Kharijul et al have validated that pharmacists are well-positioned to enhance patient knowledge and adherence to a prescribed regimen, which has led to a positive impact on clinical outcomes. 4,5 The term “pharmacy extenders” has been used to describe pharmacy technicians and pharmacy students on experiential rotations, who add value to alleviate the workload, expand pharmacy presence, and enhance their professional development.…”