Pharmacists as a Means of Cost Containment in the ED

“Economic constraints have generally precluded the incorporation of ED-based clinical pharmacists, but because the enormous economic burden associated with adverse drug events, it may be more cost effective to use the high-level expertise of an in-house clinical pharmacist.”– Howard A. Peth, Jr., MD, JD 2003

1. A Study by Levy, DB. Hospital Pharmacy 1993

Largest cost savings based on clinical interventions 

2 Major interventions :
*Medication selection
*Dose change

2. Financial Impact of Emergency Medicine Clinical Pharmacist Program

–  by Morgan, SR et. al., 2018

3. Impact of Emergency Medicine Clinical Pharmacists on Clinical Outcomes

– Procopio GL et al., 2021

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EMERGENCY PHARMACY AS A PROFESSION

The benefits of the practice or service include the following:

• Improved healthcare outcomes for patients as a result of early medication reconciliation, medication order and clinical review
• Increased awareness of medicine-related issues among ED staff
• Liaison between emergency, pharmacy and other inpatient departments on medicine-related issues
• Timely supply and review of specialized medicines
• Improved communication between the ED and external services, e.g. warfarin monitoring services, residential care facilities and community pharmacies.

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Education and Training Requirements for an Emergency Pharmacist

• Successful completion of PGY-1 (pharmacy practice residency or equivalent experience) 
• Successful completion of PGY-2 in critical care or emergency medicine (General Pharmacotherapy PGY-2 acceptable) 
• Highly desired: BCPS certified. 
• Required: ACLS and PALS course completion 
• Highly desired: ATLS Course Completion (audit).

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Summary

– Emergency Medicine is a new and expanding field within medicine

– Emergency Medicine pharmacy have a history going back to the 1970s

– There are a variety of clinical and administrative tasks that are within an EMP job description

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REFERENCES

1 American College of Emergency Physicians. (Revised 2021, January). Definition of Emergency Medicine. https://www.acep.org/globalassets/new-pdfs/policy-statements/definition-of-emergency-medicine.pdf 

2 Thomas, D. (Director). (2013). 24|7|365: The Evolution of Emergency Medicine [Film]. Ann Prum. Emergency Medicine Residents’ Association. 

3 Jason Wilson. January 15, 2017. 24 7 365. [History of Emergency Medicine].https://www.youtube.com/watch?v=ceMwsvV1_xc&t=3098s. 

4 American Academy of Emergency Medicine. (n.d). AAEM History. https://www.aaem.org/about-us/our-values/history. 

5 bps Board of Pharmacy Specialties. (February 21, 2020). Emergency Medicine Pharmacy Recognized as New Specialty. https://www.bpsweb.org/2020/02/21/emergency-medicine-pharmacy-recognized-as-new-specialty/.

6 Acquisto, N & Patanwala, A. “Evolution of emergency medicine pharmacy services”, Journal of Pharmacy Practice and Research, vol.49,issue 2, April 2019, Pages 106-107. https://doi.org/10.1002/jppr.1559.

7 Fairbanks, R., Hays, D., Webster, D., Spillane, L., (2004).”Clinical pharmacy services in an emergency department” .Am J Health-Syst Pharm. 61:934-7. https://doi.org/10.1016/j.ajem.2018.01.056.

8 ashp. (n.d). ASHP Guidelines on Emergency Medicine Pharmacist Services. https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/emergency-medicine-pharmacist-services.ashx

9 Morgan SR, et al, “Clinical pharmacy services in the emergency department”, American Journal of Emergency Medicine (2018), https://doi.org/10.1016/j.ajem.2018.01.056. 

 10 Stoffel, J., Baum, R.,Dugan,A.,Bailey, A.,(2019). “Variability in training, practice, and prioritization of  services among emergency medicine pharmacists”.AM J HEALTH-SYST PHARM. 76, S21-S27. DOI 10.1093/ajhp/zxy049.

 11 Rech, M., Adams W., Smetana K., Gurnani, P., Patel M., Peppard, A., Hammond, D.,  Flannery, A., (2021). “PHarmacist Avoidance or Reductions inMedical Costs in Patients Presenting the EMergency Department”. PHARM-EM Study. Critical Care Explorations,3,1-10. DOI 10.1097/CCE.0000000000000406.  

 12 Camargo, J., Martinez, F., Jimenez, E., “The effect on potential adverse drug events of a pharmacist-acquired medication history in an emergency department: a multicentre, double-blind, randomised, controlled, parallel-group study.” BMC Health Serv Res. 2015; 15: 337. doi: 10.1186/s12913-015-0990-1. 

13 Brown, J., Barnes, C., Beasley, B., Cisneros, R., Pound, M., Herring, C., (2008). “Effect of pharmacists on medication errors in an emergency department.” Am J Health Syst Pharm. 2008 Feb 15;65(4):330-3. doi: 10.2146/ajhp070391. 

14 Thomas, M., Acquisto, N., Shirk. M., Pantawala, A., (2016). “A national survey of emergency pharmacy practice in the United States”.AM J HEALTH-SYST PHARM.73, 386-394. DOI 10.2146/ajhp150321. 

15 Weant KA, Humphries RL, Hite K, Armitstead JA. Effect of emergency medicine pharmacists on medication-error reporting in an emergency department. Am J Health Syst Pharm. 2010;67(21):1851-1855. doi:10.2146/090579

16 Roman C, Edwards G, Dooley M, Mitra B. Roles of the emergency medicine pharmacist: A systematic review. Am J Health Syst Pharm. 2018;75(11):796-806. doi:10.2146/ajhp170321.

17 Acquisto NM, Slocum GW, Bilhimer MH, et al. Key articles and guidelines for the emergency medicine clinical pharmacist: 2011-2018 update. Am J Health Syst Pharm. 2020;77(16):1284-1335. doi:10.1093/ajhp/zxaa178

18 Morgan SR, Acquisto NM, Coralic Z, et al. Clinical pharmacy services in the emergency department. Am J Emerg Med. 2018;36(10):1727-1732. doi:10.1016/j.ajem.2018.01.056

19 Procopio GL, Jain RP, Tompkins DM, Perez JM, Bicking K. Impact of a pharmacist driven anticoagulation reversal program at a large academic medical center. J Thromb Thrombolysis. Published online June 7, 2021. doi:10.1007/s11239-021-02491-7

20 Fairbanks RJ, Rueckmann EA, Kolstee KE, et al. Clinical Pharmacists in Emergency Medicine.