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.