Impact of Clinical Pharmacy Services in a Veterans Affairs Hospital Emergency Department

Problem: The Michael E. DeBakey Veterans Affairs Medical Center is a large tertiary care teaching hospital with a busy emergency department. Currently there are no pharmacy services provided in the emergency department, which is similar to national trends. Methods: A one-month pilot was arranged to place a clinical pharmacist in the emergency department during the day shift. Pharmacist interventions and activities were chronicled and translated into financial savings for the hospital. In addition to intervention tracking the pharmacist focused on Adverse Drug Event reporting and discharge counseling. Review of the number of Adverse Drug Event reports during the month was compared to the months surrounding the pilot period. Readmission rates for patients seen for Chronic Obstructive Pulmonary Disease were also compared to the months surrounding the pilot. Comparisons were made using Chi Square analysis. Results: The pharmacist made a total of 68 quantifiable interventions for a total cost avoidance of $97,953.90. In addition, the pharmacist completed 207 medication reconciliations, 29 discharge counseling sessions, and a small number of other interventions. There were a total of 10 Adverse Drug Events reported during the pilot period, which demonstrated a significant increase in reporting during the pilot (p < 0.01). There was no difference seen in readmission rates. Conclusions: Addition of a clinical pharmacist to the emergency department resulted in significant cost savings for the hospital. In addition, there was a significant increase in Adverse Drug Event reporting, which would more accurately reflect the number of medication events in the hospital.