Extensive Acute Care Interventions to Decrease Patient LOS

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Last week’s Tip explored pharmacists creating value in a health systems. This week, we examine a more comprehensive set of pharmacist-based interventions in a particular hospital. As discussed last week, pharmacists can and must demonstrate the value of their services. This is true anywhere, but in hospitals this might be especially the case given that the pharmacy is now viewed as a cost center with high inventory and labor costs in prospective payment systems based on diagnostic –related groups (DRGs). Under DRGs, length of stay (LOS) becomes a very important outcome. The hospital, while at once balancing the need to prevent frequent readmissions, still needs to minimize LOS for patients, particularly when extended LOS is caused by inefficient or ineffective care.

Leary et al evaluated the impact of pharmacist-driven interventions on LOS in the acute care setting. They employed a pretest-posttest design to compare the effect of pharmacist interventions across 3 practice areas (hematology/oncology, medicine, and pediatrics). The interventions included detailed chart review, prescriber consultations, and targeted pre-discharge services, such as discharge prescription writing (with provider cosignature). A total of 924 patients (466 pre and 458 post) were included in the analysis. The median LOS decreased from 4.95 to 4.12 days from the pre versus post groups, respectively. There was no difference in readmission rates between groups. Interviews of participating pharmacists revealed several themes, including positive impact on professional development, and increased relevance for participating in positive outcomes and interdisciplinary care. The study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists' responsibilities.

The average reduction in LOS of nearly one day saves several thousand dollars for the hospital for each patient. Multiplied hundreds of times over, this results in extraordinary savings. Pharmacy managers can integrate their staff pharmacists into a range of activities that demonstrate value to hospital leadership and advance the case for pharmacy if the manager approaches these situations from the proper perspective. If executed properly, this also promotes job satisfaction among the participating pharmacists.

Additional information about Creating and Managing Value and Implementing Value-Added Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Leary MH, Morbitzer K, Walston BJ, et al. Evaluation of targeted pharmacist interventions to reduce length of stay in an acute care practice model. Ann Pharmaco. 2018; Nov 18:1060028018815064. doi: 10.1177/1060028018815064.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California