Background: U.S. healthcare costs are rising due to the increase in polypharmacy, which is a potential risk factor for hospital readmission.1 In a cohort study of 5,507 patients with ≥10 discharge medications, more than 25% of them were readmitted.1 At one of the largest public county hospitals in the U.S., readmission rates for patients with high-volume home medications (≥10) are high. To address this issue, an inpatient pharmacist-driven transition of care (IPTC) program was developed in collaboration with an interdisciplinary healthcare team. The goal of this study is to determine the impact of the IPTC program on decreasing related readmissions and improving patient safety.

Methods:

The IPTC program seeks to reduce 30-day readmissions to ≤10% in patients with ≥10 home medications upon admission to the general medicine floors (October 2015 to September 2016). The IPTC team, consisting of pharmacists and 4thyear pharmacy students, conducts a four-fold intervention process by 1) obtaining medication histories, 2) performing medication reviews, 3) providing one-on-one inpatient medication consultations and 4) calling patients within 72 hours post-discharge to educate them on their medications. Any discrepancies or interventions are communicated to healthcare providers for clarification and correction. All encounters are documented in patients’ electronic health records (EHR). 30-day readmission rates over time were analyzed using the Cochran-Armitage trend test.

Results:

The pre-intervention period from July to September 2015 showed a mean 30-day readmission rate of 30.8% in patients with high volume medications. After the implementation of the IPTC program, the mean readmission rate was reduced to 5.7% (97 readmissions out of 1680 discharges) from October 2015 to September 2016. There was a statistically significant decreasing trend in the 30-day readmission rate over time (p<0.0001, Figure 1).

Conclusions:

Among patients with ≥10 home medications, the IPTC program significantly contributed to improved patient safety as evidenced by reduced related readmission rates over time. The main limitation of this study is that pre-intervention results prior to implementation of the program were limited to a 3-month period due to the transition to a new EHR program. Further studies are needed to determine which other patient populations may benefit from this program. The IPTC program highlights the expanding role of pharmacists in collaboration with other healthcare providers to deliver the most optimal and safe patient care.

Citations:

1. Picker D, Heard K, Bailey TC, Martin NR, LaRossa GN, Kollef, MH. The number of discharge medications predicts thirty-day hospital readmission: a cohort study. BMC Health Services Research. 2015;15:282-289.