The Effect of Integrating Clinical Pharmacists in Norwegian Emergency Departments (The PharmED Study)—A Stepped Wedge Trial
B. H. Garcia, K. Svendsen, T. Johnsga˚rd, E. C. Lehnbom, E. H. Ofstad, T. Risør, L. Røslie, L. Sma˚brekke, R. V. Holis, B. Zahl-Holmstad, T. Wisløff, R. Elenjord
Executive Impact: Transforming Emergency Care
The PharmED study demonstrates the significant positive impact of clinical pharmacists in Norwegian Emergency Departments on patient outcomes and healthcare efficiency.
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Hours Reduced (30-day LOS)
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Hours Reduced (Index LOS)
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Patients Included
Deep Analysis & Enterprise Applications
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Background
Clinical pharmacists in emergency departments (EDs) contribute to improving patient care, enhancing medication safety, and optimizing outcomes by identifying medication errors, preventing medication-related problems and reducing inappropriate medication use. However, in Norway, pharmacists are not routinely integrated into the interprofessional ED team.
Aim
The primary aim of the PharmED-study (1) was to investigate the impact of ED pharmacists on length of stay in hospital (LOS) during a 30-day follow-up from ED admission. Secondary outcomes included LOS during index visit and any revisit(s), time to readmission, and mortality.
Methodology
This was a stepped-wedge, non-randomized cluster trial included all patients admitted to three EDs (100-250-beds) in Northern Norway between February 2021 and January 2022. Clinical pharmacists provided medication reconciliation, medication review, and medication counselling during weekday shifts (8:00 AM-7:00 PM). Median linear regression, adjusted for study site, was used to analyse LOS. Time to hospital revisit was analysed applying Cox regression model, also adjusted for study site.
Key Results
A total of 39,413 patients with 48,345 ED visits were included, with 24,756 patients in the intervention group and 17,782 in the control group. The intervention significantly reduced the primary outcome, LOS during the 30-day follow-up, by -0.053 days (equivalent to 1.26 h) in the intervention group compared to the control group (95% CI: -0.090, -0.015; p = 0.006). A significant reduction was also observed for LOS during the index hospitalization, with a decrease of -0.040 days (equivalent to 0.97 h) in the intervention group (95% CI: -0.065, -0.015; p = 0.002). No significant effects were observed for other secondary outcomes. LOS during readmission showed a coefficient of -0.130 days (95% CI -0.422, 0.162, p = 0.383) for the intervention group compared to the control group. Similarly, odd ratio for 30-day mortality in the intervention group was 0.93 (95% CI; 0.81, -1.07, p = 0.29) compared to the control group. The Hazard ratio for readmissions in the intervention group was 1.059 (95% CI 1.000,1.121).
Conclusion
The integration of clinical pharmacists into ED teams in three Norwegian hospitals led to statistically significantly reductions in LOS during both the index hospitalization and the 30-day follow-up period. The findings highlight the potential for pharmacists to contribute to more efficient healthcare delivery. Policymakers should consider legislating the inclusion of pharmacists into ED teams and allocating resources for their education and training. Future studies should explore the long-term clinical and economic impacts of this intervention.
Enterprise Process Flow
Stepped-wedge, non-randomized cluster trial
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3 EDs (100-250 beds) in Northern Norway
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Feb 2021 - Jan 2022
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Clinical pharmacists provided medication reconciliation, review, counselling (weekday 8AM-7PM)
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Median linear regression (LOS), Cox regression (readmission)
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Impact on LOS (primary), revisit(s), readmission, mortality (secondary)
| Outcome | Intervention Group | Control Group | Significance |
|---|---|---|---|
| Patients Included | 24,756 | 17,782 | N/A |
| 30-day LOS Reduction | -0.053 days (1.26h) | Baseline | p = 0.006 |
| Index LOS Reduction | -0.040 days (0.97h) | Baseline | p = 0.002 |
| 30-day Mortality (Odds Ratio) | 0.93 (0.81-1.07) | 1.00 | p = 0.29 |
| Readmissions (Hazard Ratio) | 1.059 (1.000-1.121) | 1.00 | No significant effect |
Enterprise Application: Optimizing Hospital Pharmacist Integration
The PharmED study provides a clear model for integrating clinical pharmacists into high-pressure environments like Emergency Departments. Our analysis indicates that structured programs for medication reconciliation, review, and counselling during peak hours can significantly improve patient outcomes and operational efficiency. Implementing such a model within an enterprise healthcare system requires a phased approach, starting with pilot programs in high-volume EDs and gradually expanding based on demonstrated ROI. This ensures optimal resource allocation and clinician buy-in.
- Reduced Length of Stay (LOS)
- Enhanced Medication Safety
- Improved Patient Outcomes
- Optimized Resource Utilization
- Stronger Interprofessional Collaboration
Implementation Steps
- Pilot integration in 1-2 high-volume EDs
- Establish standardized protocols for pharmacist interventions
- Provide dedicated training and resources for ED pharmacists
- Monitor and evaluate clinical and economic impacts
- Scale intervention across the healthcare system
Calculate Your Potential ROI
Estimate the potential savings and reclaimed hours for your enterprise by optimizing medication management with AI-driven insights.
Annual Savings
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Hours Reclaimed Annually
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Strategic Implementation Roadmap
A phased approach to integrating AI-powered insights into your enterprise, ensuring sustainable transformation and measurable impact.
Phase 1: Pilot & Validation
Implement AI-driven analysis in a select department to gather baseline data and validate initial ROI projections.
Phase 2: Scaled Integration
Expand AI tools to additional departments, focusing on high-impact areas identified in the pilot phase, with continuous monitoring.
Phase 3: Full Enterprise Rollout
Integrate AI across the entire organization, leveraging insights for proactive decision-making and continuous optimization.
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