Improving patient outcomes and decreasing length of stay through pharmacist participation in case management rounds

Purpose: This study demonstrates the impact of a pharmacist on collaborative multidisciplinary patient care rounds in a community hospital in an effort to help facilitate discharge and decrease length of stay (LOS). 

Methods: Patients located on the medical, surgical, and oncology floors who had been hospitalized for 3 or more days were targeted by financial class (Medicare, charity, and self-pay). A multidisciplinary team consisting of, but not limited to, physicians, pharmacy, nursing, and case management met daily to discuss patients’ needs and intervene as necessary.  Pharmacists reviewed profiles identifying opportunities in antimicrobial stewardship, drug regimen modification, IV to PO conversions, anticoagulation management, renal dosing, and meeting core measure requirements.  LOS data was analyzed pre and post pharmacist participation.  Additionally, a sub-analysis of interventions documented from February through May 31, 2012 was evaluated, and a cost savings analysis was performed.      

Results: Length of stay prior to multidisciplinary rounds was 5.48 days, and after 3.5 months of rounds with a pharmacist LOS decreased to 4.88 days.  Interventions made by the pharmacists included 119 in antimicrobial stewardship, 196 in general drug regimen modifications, 123 IV to PO conversions, 25 in anticoagulation management, 8 renal dose adjustments, and 42 interventions related to core measure requirements.  Cost savings from pharmacy interventions was $21,675.  Additionally, opportunities for patient education, pain management, adverse drug reactions, and counseling on discharge were identified.

Conclusion: Length of stay was decreased by 0.6 days through pharmacist participation in rounds, and total cost savings from interventions made was $21,675.  This demonstrates that pharmacist involvement can help facilitate safe and timely discharge from the hospital.