Reducing Discharge Delay Through Resident-Pharmacist Colocation: A Pilot Study

Abstract

Background and Objectives: Discharge delay of hospitalized patients is costly, inefficient, and can impede care of pending admissions. Through pharmacist colocation and daily discharge medication reconciliation meetings, we aimed to improve discharge efficiency and decrease the number of electronic pages. Methods: We conducted a quality improvement initiative on the family medicine inpatient teaching service at a large academic medical center using two interventions: colocation and daily discharge medication reconciliation meetings of pharmacist and family medicine residents. We assessed: (1) discharge delay, defined as the time between discharge order and pharmacist’s completion of discharge medication reconciliation and patient education; (2) the number of electronic messages between the pharmacist and family medicine team, assessed 1 month before and 1 month after implementation of the interventions. We also assessed team members’ postinitiative views on collaboration, discharge safety, and timeliness, and knowledge acquisition using three 5-point Likert statements. Results: Ninety-five preintervention and 54 postintervention patients met eligibility criteria. Discharge delay prior to intervention was 72.7±58.4 minutes and 47.6±37.4 minutes postintervention. The number of electronic messages between pharmacist and family medicine team pager decreased from 118 to 14 during the months studied. Team members felt collaboration, safe and timely discharges, and acquisition of new knowledge improved. Conclusions: Colocation of workspaces and daily medication reconciliation meetings were associated with decreased discharge delay and decreased pages between team members. Further study is needed to assess its reproducibility, impact on resident education and patient satisfaction, cost-effectiveness, and ability to scale to other services.

Exploring pharmacists' perspectives on preparing discharge medicine lists: A qualitative study

“… 41 Due to this, several interview participants believed it would be more efficient if pharmacists could plan the discharge reconciliation for checking and signoff by the doctors, rather than the other way round. Although pharmacists performing discharge reconciliations are associated with a significant reduction in medicine errors, 42 this may reduce a junior doctor's opportunity to develop their medicine and prescribing knowledge 43 and needs to be considered in terms of the pharmacy workforce.…”

Importância do farmacêutico na alta hospitalar qualificada: Revisão integrativa

“…Além disso, obteve tempo de permanência e taxa de readmissão reduzidos, com maiores mudanças quando a intervenção completa da farmácia foi concluída. (Bonk, Milsap, Goplen, McElray & Rabago, 2020) Reduzir permanência hospitalar através da inserção do farmacêutico na equipe de medicina da família, mantendo diariamente reuniões da equipe relacionados a alta.…”

“…Em outro estudo, cerca de 74% tiveram pelo menos 1 (uma) discrepância em sua lista de medicamentos (Choi & Babiak, 2018). As reuniões para RM de alta permitem ao farmacêutico uma supervisão integral e o fornecimento de orientações que melhoram a segurança do paciente (Bonk et al, 2020). Al-Hashar et al (2018) comparou um grupo com intervenção de RM de alta e outro sem essa intervenção, constatando que o grupo que vivenciou a intervenção conteve 27 (vinte e sete) Eventos Adversos a Medicamentos (EAM) evitáveis.…”

“…O tempo de permanência hospitalar foi reduzido quando implementado um serviço de alta farmacêutica, em um estudo foi de 3,6 dias comparado ao grupo sem alta farmacêutica 5,3 dias (Fosnight et al, 2020). Concomitantemente, o atraso na alta foi reduzido em aproximadamente 25 (vinte e cinco) minutos quando o farmacêutico foi incluído no plano de alta hospitalar (Bonk et al, 2020)…”