In June 2006, our 760bed academic institution began a Hospitalist Service employing six physician providers. Similar to national trends, the needs quickly outpaced the supply of hospitalists resulting in poor provider satisfaction, delays in treatment, and concerns about quality. In addition, formulary constraints as well as an increase in providers who trained at institutions where diseases/treatments differed from those at our institution led to a perceived inability to adequately care for patients. To provide additional support to the hospitalist service, a clinical pharmacy specialist position was established.
In February 2007, 1.0 FTE was dedicated for a Hospitalist clinical pharmacy specialist. The pharmacist answered calls while inhouse during business hours Monday through Friday and via an oncall pager after hours and on weekends. In November 2009, an electronic medical record (EMR) that allowed for consult requests was implemented. Providers could choose from ten options including items such as admission medication history, discharge medication reconciliation, home IV antibiotic notification, pain medication management, and a transitional care unit for high risk readmissions. Interventions were documented between December 2007 and October 2011 and categorized into the following groups: antimicrobial stewardship, drug information (dosing; IV to oral equivalents; side effects; drug toxicities); therapy modification or initiation, education (pharmacy residents, housestaff, students), care coordination/continuity of care, and medication reconciliation. National Benchmarking Data from the 2010 Thomas Reuters Action OI Clinical Pharmacy Worksheet was used to calculate cost savings as appropriate.
There were a total of 7,267 interventions recorded; however, adequate information for analysis was available on 6,290 interventions. Of these 6,290 interventions, 9.9% were formal consultations entered by the provider into the EMR, and the remaining were interventions documented by the clinical pharmacy specialist. The most common request was for antimicrobial stewardship which accounted for 42% of the total consults. This was followed by general drug information (7.5%), new therapy recommendations (5.6%), and medication reconciliation (5.3%). These interventions were associated with a $1,249,325.00 cost avoidance based on national benchmarking.
The addition of a clinical pharmacy specialist to the hospitalist teams is a valuable asset and can result in significant cost avoidance. Our figure represents an underestimation of the actual dollars saved because of a lack of information available on cost avoidance for all clinical pharmacy services.
To cite this abstract:Berge C, Reed G, Alvarez K, Shah M, Johnson V. Cost Avoidance Through the Use of a Dedicated Clinical Pharmacy Specialist on a Hospitalist Service. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97632. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/cost-avoidance-through-the-use-of-a-dedicated-clinical-pharmacy-specialist-on-a-hospitalist-service/. Accessed May 21, 2019.