Impact of pharmacist-led transitions of care model on length of hospital stay and 30-day readmission rates at a quaternary care hospital: A pilot study

Background

Data about the impact of pharmacist-led transitions of care (TOC) approach are not well established.

Objectives

The objective of this pilot study was to evaluate the impact of pharmacist-led TOC enhanced workflow on the length of hospital stay (LOS) and the 30-day hospital readmission rates (HRRs).

Methods

This is a quality improvement pilot project conducted at a quaternary care hospital in the United Arab Emirates over 6 weeks on a medical floor and 4 weeks on a cardiac floor. TOC was defined as admission medication reconciliation (AMR) and discharge medication reconciliation (DMR).

Results

The median LOS was statistically significantly lower in patients who received AMR on the medical floor (4 days [3-8]) than those who did not (7 days [4-20]) (P < 0.001). The median LOS on the cardiac floor was not statistically significantly affected—3 (1.75-8) versus 3 (1-8) (P = 0.736). However, the multivariate linear regression model, adjusting for the number of interventions, indicated that LOS was statistically significantly lower on both floors; AMR was an independent risk factor for reducing the LOS on the medical floor (B = −8.37 [95 CI −11.37 to −5.36], P = .001) and on the cardiac floor (B = −2.76 [95% CI −5.23 to −0.28], P = 0.029). The 30-day HRR was not different on the medical floor but was numerically lower on the cardiac floor in patients who received DMR alone (12.9%) than in those who did not (17.2%) (P = 0.476). However, the multivariate logistic regression analysis, adjusting for number of interventions, indicated that the pharmacist-led AMR and DMR combined were numerically associated with lower rates of 30-day HRR with respective odds ratios of 0.64 (95% CI 0.3–1.38) and 0.83 (95% CI 0.4–1.9) (P = 0.83) on the medical floor and of 0.96 (95% CI 0.3–2.6) and 0.7 (95% CI 0.3–1.8) (P = 0.28) on the cardiac floor. In addition, the impact of the described pharmacist-led TOC approach on health care costs at the hospital was quantifiable and reflected a median medications utilization cost of $1142.95 (639.69-2444.88) when TOC is performed versus $1371.54 (402.92-4277.39) without TOC (P < 0.001) on the medical floor and of $4728.98 (2436.66-6846.34) versus $5252.79 (3907.63-7784.57) (P < 0.001) on the cardiac floor throughout the study time period.

Conclusion

Pharmacist-led TOC interventions, specifically AMR, significantly reduced the LOS on the medical and the cardiac floors, whereas both AMR and DMR represented promising predictors of decreased 30-day HRR on the studied floors. Furthermore, the TOC interventions were generally associated with a statistically significant financial impact on both studied floors.