Impact of transplant pharmacists on length of stay and 30-day hospital readmission rate: a single-centre retrospective cohort study.

OBJECTIVES: Our study was conducted to evaluate the impact of clinical transplant pharmacy services on the kidney transplant programme at our centre, following the introduction of these services in terms of inpatient length of stay (LOS) and all-cause 30-day readmission rates by comparing these data to data from before (and therefore in the absence of) the services.
METHODS: This was a single-centre retrospective cohort analysis. Data were collected in two phases: phase I (pre-transplant pharmacist period, that is, transplant pharmacist service was not available) comprised transplant patients between 1 October 2015 and 30 September 2016 and phase II (post-transplant pharmacist period) comprised transplant patients between 1 October 2016 and 30 September 2017. Patients ≥18 years of age, who received a kidney transplant in our centre, and received steroids, tacrolimus and mycophenolate for maintenance immunosuppression, were included. Transplant pharmacy services provided followed the expectations of the Centers for Medicare & Medicaid Services for transplant centres. Primary outcomes were LOS after transplant surgery and all-cause 30-day hospital readmission rate. Secondary outcomes included the number of pharmacy notes, the achievement of therapeutic levels of tacrolimus at day 7 post-surgery and delayed graft function.
RESULTS: The two groups (n=101 in phase I and n=104 in phase II) had similar demographics and transplant characteristics at baseline. There was a statistically significant difference in the inpatient LOS (6.58 vs 5.76 days; p=0.041) between phase I and phase II, respectively. However, this did not pan out in the rate of 30-day hospital readmission (36 (35.6%) vs 27 (25.9%); p=0.133) between the two phases. The number of transplant pharmacist notes pre-transplant, post-surgery and on discharge were significantly higher in the post-transplant pharmacist group. There was no significant difference in tacrolimus concentration at day 7 (mean 7.15 ng/mL in phase I vs 6.95 ng/mL in phase II; p=0.673) or delayed graft function.
CONCLUSION: Our study showed a favourable inpatient LOS and comparable 30-day hospital readmission rate before and after the implementation of transplant pharmacy services. © European Association of Hospital Pharmacists 2021. No commercial re-use. See rights and permissions. Published by BMJ.