Sammuel V Anderegg1, Samaneh T Wilkinson2, Rick J Couldry2, Dennis W Grauer2, Eric Howser2. 1. Sammuel V. Anderegg, Pharm.D., M.S., BCPS, is Pharmacy Manager, Oncology Service Line, Georgia Regents Medical Center, Augusta, GA; at the time of writing, he was Postgraduate Year 2 Health-System Pharmacy Administration Resident, The University of Kansas Hospital (UKH), Kansas City, and University of Kansas School of Pharmacy, Lawrence. Samaneh T. Wilkinson, Pharm.D., M.S., is Assistant Director of Pharmacy, Clinical Services; and Rick J. Couldry, B.S.Pharm., M.S., FASHP, is Director of Pharmacy, UKH. Dennis W. Grauer, M.S., Ph.D., is Associate Professor and Graduate Program Director, University of Kansas School of Pharmacy. Eric Howser is Decision Support Systems Specialist, UKH. sanderegg@gru.edu. 2. Sammuel V. Anderegg, Pharm.D., M.S., BCPS, is Pharmacy Manager, Oncology Service Line, Georgia Regents Medical Center, Augusta, GA; at the time of writing, he was Postgraduate Year 2 Health-System Pharmacy Administration Resident, The University of Kansas Hospital (UKH), Kansas City, and University of Kansas School of Pharmacy, Lawrence. Samaneh T. Wilkinson, Pharm.D., M.S., is Assistant Director of Pharmacy, Clinical Services; and Rick J. Couldry, B.S.Pharm., M.S., FASHP, is Director of Pharmacy, UKH. Dennis W. Grauer, M.S., Ph.D., is Associate Professor and Graduate Program Director, University of Kansas School of Pharmacy. Eric Howser is Decision Support Systems Specialist, UKH.
Abstract
PURPOSE: The impact of an innovative medication reconciliation and discharge education program on 30-day readmissions and emergency department (ED) visits was evaluated. METHODS: An observational pre-post analysis was conducted at an academic medical center to compare rates of hospital readmissions and return to ED visits during three-month periods before and after implementation of a restructured pharmacy practice model including (1) medication reconciliation at transitions of care for every patient and discharge education for a high-risk subgroup, (2) new or expanded services in the preanesthesia testing clinic and ED, (3) a medication reconciliation technician team, and (4) pharmacist-to-patient ratios of 1:30 on acute care floors and 1:18 on critical care units. The primary outcome was the composite of rates of readmissions and return to ED visits within 30 days of discharge. RESULTS: A total of 3,316 patients were included in the study. Pharmacy teams completed medication reconciliation in 95.8% of cases at admission and 69.7% of cases at discharge. Discharge education was provided to 73.5% of high-risk patients (defined as those receiving anticoagulation therapy or treatment for acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure, or pneumonia). No significant difference was observed between the preimplementation and postimplementation groups with regard to the primary outcome. In the high-risk subgroup, there was a significant reduction in the 30-day rate of hospital readmissions, which declined from 17.8% to 12.3% (p=0.042); cost projections indicated that this reduction in readmissions could yield annual direct cost savings of more than $780,000. CONCLUSION: Implementation of a team-based pharmacy practice model resulted in a significant decrease in the rate of 30-day readmissions for high-risk patients.
PURPOSE: The impact of an innovative medication reconciliation and discharge education program on 30-day readmissions and emergency department (ED) visits was evaluated. METHODS: An observational pre-post analysis was conducted at an academic medical center to compare rates of hospital readmissions and return to ED visits during three-month periods before and after implementation of a restructured pharmacy practice model including (1) medication reconciliation at transitions of care for every patient and discharge education for a high-risk subgroup, (2) new or expanded services in the preanesthesia testing clinic and ED, (3) a medication reconciliation technician team, and (4) pharmacist-to-patient ratios of 1:30 on acute care floors and 1:18 on critical care units. The primary outcome was the composite of rates of readmissions and return to ED visits within 30 days of discharge. RESULTS: A total of 3,316 patients were included in the study. Pharmacy teams completed medication reconciliation in 95.8% of cases at admission and 69.7% of cases at discharge. Discharge education was provided to 73.5% of high-risk patients (defined as those receiving anticoagulation therapy or treatment for acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure, or pneumonia). No significant difference was observed between the preimplementation and postimplementation groups with regard to the primary outcome. In the high-risk subgroup, there was a significant reduction in the 30-day rate of hospital readmissions, which declined from 17.8% to 12.3% (p=0.042); cost projections indicated that this reduction in readmissions could yield annual direct cost savings of more than $780,000. CONCLUSION: Implementation of a team-based pharmacy practice model resulted in a significant decrease in the rate of 30-day readmissions for high-risk patients.