In tough economic times, it is still possible to start an emergency department (ED) pharmacy and actually save money in the process.
That is the experience reported in a study of an ED pharmacy at Franciscan Saint Margaret Health (FSMH), in Hammond, Ind (Am J Health Syst Pharm 2012;69:1682-1686). By shifting existing staff pharmacists to the ED to perform medication reconciliation, the hospital documented $225,000 in cost savings and also improved the accuracy of reconciliation efforts.
From the start, the ED pharmacy initiative at FSMH was focused on medication reconciliation. But its use of existing pharmacy staff to perform that task was something of a pivot for the program, lead author Bhavik Nana,
PharmD, told Pharmacy Practice News. The hospital initially had received approval to hire three pharmacy technicians for the program, but because of economic conditions, the planned positions were eliminated. If an ED pharmacy were to be established, it would need to begin with no additional funding for technicians or pharmacists.
“That’s basically what we did,” Dr. Nana noted. To launch the program, two pharmacists were secured for the ED program from FSMH’s existing full-time equivalent (FTE) staff. Staffing schedules were adjusted, with the pharmacists providing ED services from 11:30 a.m. to 5:30 p.m. on weekdays. The manager of the central order-entry pharmacy agreed to expand hours of coverage at no additional cost. A small, centrally located area in the ED became an ED pharmacy workspace. The two pharmacists received training in admission medication reconciliation and critical care drugs, and were certified in advanced cardiac life support and pediatric advanced life support.
Commercially available pharmacy intervention software was used to document interventions. A retrospective chart review of a random sample of admission medication reconciliations (N=102) showed that 90.2% of reconciliations (46 of 51) performed by pharmacists were accurate compared with 66.7% of those (34 of 51) performed by nurses (P<0.05). A survey of ED admitting nurses and physicians found that the ED pharmacists were well received. Annualized cost savings attributable to pharmacist activities totaled $225,000, including both soft-dollar and hard-dollar cost savings. Soft-dollar cost savings resulted from projected cost avoidance, for example, owing to medication reconciliations; hard-dollar cost savings resulted directly from accepting a pharmacist recommendation, such as for a drug choice.
Dr. Nana said he is proud of the successes documented in the study. “This is a challenging time for the health care field,” he stressed. “One of the challenges health care facilities are facing is [reduced] reimbursement rates. We have to work harder with the same limited resources. This study is a good demonstration of how even in these [challenging economic] times, new programs like this can be initiated to help improve patient care at the hospital.”
Christopher J. Edwards, PharmD, BCPS, a clinical staff pharmacist in emergency medicine at the University of Arizona Medical Center–University Campus, in Tucson, pointed to some shortcomings in the FSMH study. “Reallocation of inpatient staff to the [ED] may not be applicable to all hospitals,” Dr. Edwards said. “Pharmacists working in an [ED] should ideally have specialized training.”
Additionally, “I would have liked to see a breakdown of hard versus
soft money. They didn’t differentiate. Soft money is not as impressive
as hard when trying to persuade administrators.”
However, Dr. Edwards said he considers the study “interesting because it describes a smaller community hospital—17 beds in the emergency department. Most of the literature comes from large teaching hospitals.”
He also gave kudos to the researchers for their thorough approach to documentation. “The paper stresses the importance of documentation to present to the administration to justify the cost,” he said. “Documentation, documentation, documentation. Getting your foot in the door is the hardest part.” He added, “You have to present and make a case. The tighter the budget, the more difficult it will be [to convince hospital administrators].”
For FSMH, there are indications that those budget pressures may be lifting, in part due to more recent successes with their ED pharmacy initiative. “In the article, we mentioned approval for 4.5 FTE technicians and these positions are currently in the process of being filled,” Dr. Nana said. “Overall, the hours have been expanded to 20 hours of coverage a day, seven days a week from our initial six hours of coverage, five days a week. In addition, due to the positive results seen, a sister hospital, Franciscan St. Margaret Health–Dyer, has also initiated an ED pharmacy program at their site.”
Drs. Nana and Edwards reported no relevant financial conflicts of interest.