Integration of a clinical pharmacist into a Canadian, urban emergency department: a prospective observational study

OBJECTIVE: To evaluate the clinical and cost implications generated by a newly integrated ED pharmacist in a Canadian urban, university-affiliated tertiary care hospital. METHODS: A pharmacist documented all interventions that took place over a 5-week period. Interventions were assessed by a review panel for clinical significance and probability of harm had the intervention not occurred. Direct medication cost and cost avoidance as a result of interventions were calculated. KEY FINDINGS: The ED pharmacist made 421 interventions during the study period, 204 (48%) interventions were accepted at the time they were presented to the prescriber. After review, 53.9% of interventions were considered significant, and 52.9% were given a probability of patient harm of ≥50% had the intervention not occurred. Interventions resulted in an increase in direct medication costs of $1270, but generated a cost avoidance of $160 709. The projected direct medication cost estimate for one year was $13 208 with a cost avoidance of over $1.6 million. CONCLUSION: The integration of a pharmacist into a Canadian ED resulted in patient care interventions that were assessed as clinically significant, with a substantial projected cost avoidance.