Introduction: An ideal Critical care pharmacist (CCP)-to-patient ratio has not been established, and existing literature has aimed to explore the relationship between pharmacist workload and its impact on patient-centered outcomes in the ICU. The purpose of this study is to further characterize the association between CCP workload and patient-centered outcomes following acute care practice model changes at an academic hospital. Methods: A single-center, observational, cohort study was conducted at a 333-bed academic hospital in Indianapolis, Indiana. This institution’s pharmacy department underwent practice model changes in February 2024. The pre-acute care practice model (ACPM) group occurred from August 2023 to January 2024, and the post-ACPM group occurred from October to December 2024. The primary outcome was in-hospital mortality. Patients were included in the study if they were admitted to an ICU service during the prospective study period. Results: We observed a lower in-hospital mortality, in the pre-ACPM group compared to the post-ACPM group (11% vs. 17%; p < 0.001). We also observed a shorter median initial ICU length of stay (LOS) in the pre-ACPM group 2 (1 -4) vs. 3 (2 – 7) days; p < 0.001) as well as total mechanical ventilation duration [2 (1 – 6) vs. 3 (2 – 8); p < 0.001. We observed a correlation between mortality and MRC-ICU score correlation coefficient (r) = 0.407, P < 0.001 and a novel ICU clinical score (r= 0.3, p < 0.001). Conclusions: This study further characterizes the changes in CCP-to-patient ratios and associated clinical outcomes following pharmacy department practice model changes in adult ICU patients. We observed lower in-hospital mortality, initial and total ICU LOS, and mechanical ventilation duration in the pre-ACPM group, while observing no difference in Medication Regimen Complexity- ICU (MRC-ICU) scores, in the setting of a similar CPP-to-ICU-patient ratio and a higher CCP-to-total-patient ratio. The study also found a correlation between a novel ICU clinical score and outcomes of mortality, ICU LOS, duration of mechanical ventilation, delirium incidence, MRC-ICU score, and SOFA scores. This may demonstrate clinical utility of this novel ICU clinical scoring tool for prioritizing clinical patient review when integrated into the electronic medical record.
Garelli et al. (Sun,) studied this question.