A Medical Resident-Pharmacist Collaboration Improves the Rate of Medication Reconciliation Verification at Discharge.

BACKGROUND: At the Hospital of the University of Pennsylvania (Philadelphia), it is standard practice to perform medication reconciliation at patient discharge. Although pharmacists historically were available to assist resident physicians in the discharge medication reconciliation process, the process was never standardized. An internal review showed a 60%-70% rate of pharmacist review of discharge medication lists, potentially enabling medication errors to go unnoticed during transitions of care. In response, a medical resident- and pharmacist-led collaboration was designed, and a pre-post-intervention study was conducted to assess its effectiveness. METHODS: A new work flow was established in which house staff notified pharmacists when a preliminary discharge medication list was ready for reconciliation and provided access for pharmacists to correct medication errors in the electronic discharge document with physician approval. Length of stay, average time of day of patient discharge, and readmission data were compared in the pre- and post-intervention periods. RESULTS: There were 981 discharges in the preintervention period and 1,207 in the postintervention period. The rate of pharmacist reconciliation increased from 64.0% to 82.4% after the intervention (p<.0001). The average number of errors identified and corrected by pharmacists decreased from 0.979 to 0.862 per discharge (p<.0001). There was no significant change in readmission rates or time of discharge after the intervention. CONCLUSIONS: Redesigning the discharge medication reconciliation process in a teaching hospital to include a review of medical resident discharge medication lists by pharmacists provided more opportunities for discharge medication error identification and correction.

Improving sepsis care through systems change: the impact of a medical emergency team.

The Hospital of the University of Pennsylvania achieved a significant reduction in the time between prescription and administration of antibiotics by embedding a pharmacist in an MET to facilitate antibiotic delivery.

Cost-effectiveness of hepatitis A-B vaccine versus hepatitis B vaccine for healthcare and public safety workers in the western United States.

OBJECTIVE: To determine the cost-effectiveness of substituting hepatitis A-B vaccine for hepatitis B vaccine when healthcare and public safety workers in the western United States are immunized to protect against occupational exposures to hepatitis B. PARTICIPANTS: A cohort of 100,000 hypothetical healthcare and public safety workers from 11 western states with hepatitis A rates twice the national average. DESIGN: A Markov model of hepatitis A was developed using estimates from U.S. government databases, published literature, and an expert panel. Added costs of hepatitis A-B vaccine were compared with savings from reduced hepatitis A treatment and work loss. Cost-effectiveness was expressed as the ratio of net costs to quality-adjusted life-years (QALYs) gained. RESULTS: Substituting hepatitis A-B vaccine would prevent 29,796 work-loss-days, 222 hospitalizations, 6 premature deaths, and the loss of 214 QALYs. Added vaccination costs of $5.4 million would be more than offset by $1.9 million and $6.1 million reductions in hepatitis A treatment and work loss costs, respectively. Cost-effectiveness improves as the time horizon is extended, from $232,600 per QALY after 1 year to less than $0 per QALY within 11 years. Estimates are most sensitive to community-wide hepatitis A rates and the degree to which childhood vaccination may reduce future rates. CONCLUSION: For healthcare and public safety workers in western states, substituting hepatitis A-B vaccine for hepatitis B vaccine would reduce morbidity, mortality, and costs.

Considerations in darbepoetin alfa cost and reimbursement: a model for pharmacy managers.

With health care administrators focusing on the financial aspects of patient care, pharmacy budget managers must be able to evaluate all financial implications of drugs under formulary review. Clinical considerations, dosing equivalency, direct and indirect costs, payer mix, and reimbursement level are issues that should be considered by a multidisciplinary team. A pharmacoeconomic evaluation of darbepoetin alfa compared with epoetin alfa is presented as a model to help pharmacy budget managers address these issues and develop an evaluation of two high-cost drugs to determine which would be the better agent to have on their formulary.

Economic impact of bleeding complications and the role of antithrombotic therapies in percutaneous coronary intervention.

The economics of bleeding complications and the role of antithrombotic therapies in percutaneous coronary intervention (PCI) are discussed. More than 1 million PCI procedures are performed annually in the United States, at a mean cost of hospitalization of approximately $9,000 and billions of dollars in total health care costs. Ischemic complications have been reduced to the point that bleeding has become the most common complication. Bleeding complications and transfusions are also among the most costly complications in PCI, accounting for an incremental cost of hospitalization after PCI that may exceed $10,000, due to increased length of stay and the use of additional resources such as ultrasound evaluation and surgical repair of the vascular site. Anemia and transfusions are also associated with increased morbidity and mortality, contributing to additional treatment costs beyond those directly attributable to correcting the bleeding complication. In the past decade, significant reductions in heparin dose and warfarin use were associated with reduced bleeding complications, but glycoprotein IIb/IIIa inhibitors have been shown to increase the clinical and economic costs of bleeding complications. The replacement of heparin with bivalirudin is associated with significant reductions in the costs of antithrombotic therapy and in complications. Reductions in bleeding complications have become a primary target for further improvements in both clinical and economic outcomes.

Derivation of malignancy status from ICD-9 codes.

To assess the severity of illness of oncology patients, it is necessary to distinguish patients with a single primary tumor from patients with metastatic disease occurring at a secondary location remote from the primary site. We developed a ranked list of cancer groupings and an algorithm that could distinguish patients with primary and metastatic cancer even if no specific code for secondary cancer was recorded. In patients with metastatic disease, the algorithm should also distinguish the primary site from the secondary site.