Effects of pharmacy interventions at transitions of care on patient outcomes.

Purpose: An interdisciplinary group developed a care transitions process with a prominent pharmacist role.

Methods: The new transitions process was initiated on a 32-bed medical/surgical unit. Demographics, reconciliation data, information on medication adherence barriers, medication recommendations, and time spent performing interventions were prospectively collected for 284 consecutive patients over 54 days after the pharmacy participation was completely implemented. Outcome data, including 30-day readmission rates and length of stay, were retrospectively collected.

Results: When comparing metrics for all intervention patients to baseline metrics from the same months of the previous year, the readmission rate was decreased from 21.0% to 15.3% and mean length of stay decreased from 5.3 days to 4.4 days. Further improvement to a 10.2% readmission rate and a 3.6-day average length of stay were observed in the subgroup of intervention patients who received all components of the pharmacy intervention. Additionally, greater improvements were observed in intervention-period patients who received the full pharmacy intervention, as compared to those receiving only parts of the pharmacy intervention, with a 10.2-percentage-point lower readmission rate (10.2% vs 20.4%, P = 0.016) and a 1.7-day shorter length of stay (3.6 days vs 5.3 days; 95% confidence interval, 0.814-2.68 days; P = 0.0003). For patients receiving any component of the pharmacy intervention, an average of 9.56 medication recommendations were made, with a mean of 0.89 change per patient deemed to be required to avoid harm and/or increased length of stay.

Conclusion: A comprehensive pharmacy intervention added to a transitions intervention resulted in an average of nearly 10 medication recommendations per patient, improved length of stay, and reduced readmission rates.