Implementation of an Overnight Emergency Medicine Pharmacist at a Level One Trauma Center

First Author(s)

• 

  Mark Nguyen

  Intermountain Health Care
  Salt Lake City, UT

  Disclosure information not submitted.

Co-Author(s)

• SC

  Stephanie Chauv, PharmD, BCCCP

  Advanced Clinical Pharmacist
  Intermountain Medical Center, United States

  Disclosure information not submitted.
• BR

  Breyanna Reachi, PharmD, BCCCP

  Advanced Clinical Pharmacist
  Intermountain Medical Center, United States

  Disclosure information not submitted.
• JB

  Jeremy Bair, BCPS, PharmD

  Disclosure information not submitted.

Title: Implementation of an overnight emergency medicine pharmacist at a level one trauma center

Introduction: The Intermountain Medical Center (IMED) emergency department (ED) has the highest volume of patients in Utah. With the surge of COVID-19 cases during the early portion of October 2020, there was an expected increase in complex patients. Emergency medicine pharmacist (EMP) services were requested to expand from the 0700 to 2300 staffing model to 24-hour coverage. The purpose of this study was to evaluate interventions completed by overnight EMPs and the associated potential cost avoidance (CA).

Methods: This is a retrospective, descriptive analysis conducted from November 25th, 2020 through March 12th, 2021 during the expanded EMP service hours of 2300 – 0700 at IMED. EMPs documented their interventions into REDCap software and the CA associated with each intervention was based on available literature. CA taken from prior studies were inflated to the 2021 United States dollar. Interventions were separated into five different categories. Two timeframes within the past year of similar duration were compared for the secondary analysis. The primary analysis was CA associated with documented overnight EMP interventions. A secondary analysis was conducted to assess EMP impact on clinical markers, including mean time from non-contrast computerized tomography head (NCCTH) to recombinant tissue plasminogen activator (rtPA) administration and percentage of patients achieving door-to-rtPA ≤ 30 minutes, ≤ 45 minutes, and ≤ 60 minutes.

Results: There were 820 interventions documented by EMPs over 107 days that was associated with a potential CA of $612,974.31. From the documented interventions, 46% were categorized as hands-on care and contributed to 47% of the associated CA. The projected annual CA would be $2,090,986.45. The mean time from NCCTH to rtPA administration was 13 ± 5 minutes (n=6) with EMP staffing. For the compared durations without EMPs, the mean time was 32 ± 9.2 minutes (n=4) and 30 ± 18.7 minutes (n=4). All patients had a door-to-rtPA time of ≤ 45 minutes with the availability of EMPs compared to the 38% (3/8) without EMP staffing.

Conclusion: Overnight IMED EMPs were associated with a significant potential CA. EDs should allocate resources toward 24-hour EMP coverage to increase opportunities for cost avoidance and savings, in addition to maximization of patient-centered outcomes and safety.