Hospitalists, pharmacists partner to cut errors

Shorter lengths of stay, lower med costs result

Hospitalists collaborating with clinical pharmacists at Brookhaven Memorial Hospital Medical Center in East Patchogue, NY, were able to shorten length of stay, lower medication costs, and improve clinical outcomes.

A study conducted by Saeed Syed, MD, a hospitalist physician with Cogent Healthcare, a provider of inpatient management programs, compared results between patients treated by voluntary attending physicians and those treated by the hospitalist/clinical pharmacist team.

The hospitalist/clinical pharmacist group had a 23% shorter length of stay, a 21% lower cost of medications, and 1.5 fewer medications per patient than the comparable patient group treated by the voluntary attending model.

The hospitalist-pharmacist group also required less nursing care and had a reduced risk of adverse drug reactions and medication errors.

In addition, the study revealed that the hospitalist/pharmacist team at Brookhaven was able to reduce length of IV therapy for antibiotics and GI medications by 1.7 and 0.9 days, respectively.

For pneumonia patients, drug costs were reduced by an average of 29% ($507 vs. $360) per case.

Using residency program

Syed, who is the lead physician in the hospitalist program at Brookhaven, wanted to improve specific indicators including pharmaceutical aspects of care — i.e., drug expenditures, and trying to prevent medication errors. Since the hospital had an accredited and approved residency program in pharmacy, "we wanted to see how good the results would be from collaborating with them." The study took place between September 2003 and February 2004.

"What we initially intended was to use one of our in-house pharmacy graduates, but with this program, the residents were assigned to the hospitalist group in training," Syed recalls.

"They started the day with us around 7:30 in the morning, sat with us [a four-physician group and two nurse practitioners], and went over all the patients. We then went to the floors and started rounds, so the pharmacy residents accompanied us on a rotating basis," he notes.

As a result, Syed explains, the residents saw the actual care as it took place, noticed opportunities to substitute generic drugs; to perhaps move from a more expensive IV drug to an oral one; to be on guard for potential adverse drug reactions; and to help ensure proper dosage and use.

"The pharmacy residents also helped us with chart review for the pharmacy," he notes.

This collaboration came naturally at Brook-haven, adds Ken Cohen, PhD, chief of clinical pharmacology and therapeutics.

"We have a history of extreme collaboration with the medical staff," he notes. "We work closely with a number of physicians, reviewing the medications together with physician leaders and determining therapeutic choices, to consistently apply the same models to treat diseases."

The clinical pharmacist residency program was instituted to train academically superior students at the doctorate level in what Brookhaven does in clinical pharmacy and acute care, Cohen says.

"At about the same time, we developed the hospitalist program; they are here all day and are familiar with the collaborative model, so it made sense for the pharmacy residents to enter into interdisciplinary rounds with the hospitalists," he continues.

As part of the increased recent attention to medical errors, "we have heard about medications not being used exactly as they were intended. We wanted to have a pharmacist inserted in the process at the point of order generation. This way, many risks can be eliminated before pen hits paper, so to speak," Cohen explains.

Is a similar program essential?

Both Cohen and Syed agree that a hospital does not have to have a residency program similar to theirs to benefit from a hospitalist/pharmacist collaborative model.

"A residency program is not required," Cohen adds. "The advantage is the same as with medical residents — you get people who have recently emerged, are highly trained and motivated, and current as to what is possible with regard to the latest medical approaches — and frankly, their salaries are lower. But if you do not have such a program, if you can devote the time to allow a clinical pharmacist to go on rounds, there’s no reason why this model can’t work in nonresident facilities."

"Most hospitals do have a graduate pharmacist in-house," Syed notes. If not, while on the surface it may look as if you are losing some time from your pharmacist, "if you reduce drug costs 20% to 25% or cut lengths of stay by two days, it’s certainly worth it."

In addition, by preventing errors, you are avoiding the calls that then have to be made to the pharmacist as part of the follow-up, he explains.

What’s more, Cohen adds, "The payback is not just in the hospitalist area, but for all physicians who work together with pharmacists in terms of medication management. We’ve achieved certain efficiencies across all levels of the organization."

Need More Information?

For more information, contact:

• Ken Cohen, PhD, Chief of Clinical Pharma- cology and Therapeutics, Brookhaven Memorial Hospital Medical Center, East Patchogue, NY. Phone: (631) 654-7120.

• Saeed Syed, MD. Cogent Healthcare. Phone: (631) 687-4131. E-mail: