A pharmacist in an emergency department reduces length of stay

Background

Increased demand and length of stay in the emergency department (ED) is associated with increased mortality. Pharmacists working in the ED could play a vital role in prescribing time-critical medication, resolving medication related issues early in the patient journey, and making proactive interventions to enhance patient care. Despite being advocated by national bodies, there is limited evidence investigating the impact of pharmacists working in UK emergency departments.

Objectives

To assess the impact of an early pharmacist review and early medicines reconciliation in the emergency department on:

• Time to administer critical medication
• Length of inpatient stay.

Methods

This six-month study was conducted in an acute NHS Trust emergency department. Cases (intervention group) were identified using the electronic tracking board to find patients referred to, but not assessed by, a speciality clinician. An intervention of medicines reconciliation and review were performed, and clinically appropriate time-critical medicines prescribed prior to speciality clinician assessment. A control group of patients matched by age, sex, and speciality who were seen within the same month but not reviewed by an ED pharmacist were identified for comparison of time to critical medicine administration.

The length of stay of each patient in the intervention group was calculated and compared to the median length of stay for all admissions stratified by speciality within the same six-month period.

Results

The pharmacist reviewed 205 patients; 77 were prescribed a time-critical medicine. They were compared to 68 patients (controls) prescribed a time-critical medicine not reviewed by an ED pharmacist.

A statistically significant decrease in time to administration (P=0.004) was observed for patients in the intervention group, receiving time-critical medicines 3.68 hours quicker than the control group. The median length of stay of patients in the intervention group (n=143 admitted) was 5.13 days less than the median length of stay for all admissions (n=7005 admitted; P<0.001). A reduction in the mean length of stay was observed in three out of five specialities.

Conclusion

This study demonstrated the positive impact of an early pharmacist review in the emergency department and adds to the limited evidence available that an ED pharmacist review enhances patient care through early resolution of medication related issues. Although statistical analysis was used to account for variability, the small sample size was a limitation, particularly when evaluating length of stay which can be influenced by multiple factors. Further research is needed to support these initial conclusions, address limitations, and explore other potential benefits of the intervention.

Additional authors: Louisa Fullerton & Hannah Phelan, Manchester University NHS Foundation Trust; Lena Makadsi, University of Manchester

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.