In 2012, the Fairview Health System implemented a formal care transitions process that included referrals to outpatient services provided by medication therapy management (MTM) pharmacists, among other clinical services. This analysis evaluates the impact of the MTM-provided comprehensive medication management (CMM) service on readmission rates. Retrospective electronic medical record (EMR) data were used to identify hospital admissions between December 1, 2012, and July 31, 2015. Thirty- and 60-day readmission rates were calculated in both a CMM and comparator cohort. Readmission rates also were stratified by readmission risk category. A total of 43,711 patients, contributing 57,673 hospitalizations, were included in the analysis. Of those, 1291 hospitalizations had a CMM visit within 30 days of discharge (median 6 days) and were considered the CMM cohort. Patients who received a CMM visit had a significantly lower rate of 30-day readmissions (8.6% vs. 12.8%, P < 0.001). The 60-day readmission rate remained lower among CMM patients but did not reach statistical significance (15.6% vs. 17.6%; P = 0.0528). When patients in each cohort were stratified by readmission risk category, the CMM cohort had a statistically significant lower rate of 30-day readmission in the highest risk groups (Average: 7.1% vs. 9.5%, P = 0.025; Elevated: 9.9% vs. 21.4%, P < 0.001; High: 18.3% vs. 35.9%, P < 0.001; Extreme: 36.4% vs. 77.7%, P = 0.006). CMM performed by an MTM pharmacist reduces the rate of readmission at 30 days post discharge and may have the largest impact among patients at highest risk of readmission.

Objectives-A recent American study identified clinical factors which effectively predicted those patients who would have significant findings on cranial computed tomography. It was proposed to apply these criteria in a UK setting and to determine whether modifications could be made to improve their eYciency. Methods-A prospective observational study was conducted over a four month period including all non-trauma adult patients referred from the accident and emergency (A&E) department for urgent cranial computed tomography. Presenting symptoms and signs were analysed for ability to predict clinically significant computed tomography findings, namely: acute infarct, malignancy, acute hydrocephalus, intracranial haemorrhage, or intracranial infection. Results-Sixty two patients were included; 22 (35%) had significant findings on computed tomography. Applying the original criteria (any of: age 60 years or older, focal neurology, headache with nausea or vomiting, altered mental status) to the study population showed that no clinically significant tomograms would have been omitted but only 11% fewer performed. Modifying the criteria by removing "age 60 years or older" and replacing "altered mental status" with a Glasgow coma score <14, still ensured 100% sensitivity and would have resulted in 19% fewer scans being performed. Conclusion-Simple clinical criteria can be usefully applied to patients presenting to an A&E department in this country to target patients most likely to have clinically significant findings on urgent cranial computed tomography. (J Accid Emerg Med 2000;17:15-17)

Materials and methods:A prospective study was carried out for 12 months. The study included patients over 18 years treated with CIEA. Age, sex, body mass index (BMI), and the number of days the epidural catheter (EC) was in place were recorded. The following indicators were analysed: a) placement and fixation: level of training (staf f physician, resident), number of EC insertion at tempts, dural puncture, radicular pain, bleeding, type of EC fixation dressing; b) follow-up: filling-in of CIEA checklist, labelling of perfusion system, proper recording of dosage on patient records; c) incidents: administration route errors, EC removed before scheduled time, lost EC and side ef fects. Data are expressed as median (10th-90th percentiles) and percentages. The χ 2 test was used for the bivariate analysis. Results and discussion: We studied 318 patients (158 men/160 women). Median age was 62.3 years (42.0-80.1); BMI, 30.4 (21.8-41.8); and number of days EC was in place, 2.2 (1-4). Table 1 shows the results of the indicators analysed. The participation of residents in EC placement and more than 3 at tempts at EC insertion increased the percentage of incidents and complications (p=0.002 and p=0.05). The use of non-transparent dressings compared to other types reduced EC loss (p=0.05).

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