From sunset to sunrise: the role and potential value of newly established night-shift emergency department pharmacists in a community regional medical center

Purpose:   Stormont-Vail Regional Health Center (SVHC) is a 586-bed acute care facility with an Emergency and Trauma Center expecting over 60,000 patients this year.  The study objectives are:  to examine the role of the night ED Clinical Pharmacy Specialists (ED-CSPEC) and determine their value in terms of cost-avoidance and potential cost-savings.

Methods:   This retrospective study quantifies three months of high-priority interventions using i-Vents generated in the Epic electronic medical record to describe the night ED-CSPEC activities.  A pharmacoeconomic analysis was conducted to determine intervention value using Pharmacy OneSource standard intervention dollars.  For interventions not included in the model, extrapolations were used. 

Results:   During the study period, 901 interventions were documented during 78 shifts corresponding to one intervention per hour.  Interventions were made on 14% ± 5% of patients.  Monthly interventions were not statistically different between pharmacists (181 ± 61 vs. 120 ± 53; p = 0.26). The most frequent pharmacist interventions include:  providing medication/dosing recommendations to ED providers (26%), assistance to nurses on IV drug infusion rate or compatibility (16%) and response to stroke calls (8.5%).  Other interventions include participation in:  rapid sequence intubation (6.5%), procedural sedation (3.4%), drug overdose (5.5%), code blue (4.2%) and traumas (4.2%) or providing information to retail pharmacies (4.3%).  Pharmacoeconomic analysis of interventions reveal a cost-avoidance of $430,775 for the study period that translates to an annual cost-avoidance of $1,723,102 with an annual cost-savings of $1,497,886 to the institution.

Conclusions:   SVHC ED-CSPECs spend the night providing medication and dosing information to ED providers and assisting nurses with medication infusion rates and IV compatibilities.  In addition, they participate in rapid sequence intubations, code blues, traumas, procedural sedations and stroke calls as well as talking with retail pharmacies. These selected interventions alone have a significant positive financial impact and will provide over $1 million dollars in annual cost-savings to the institution.