Implementation and evaluation of a pharmacy‐driven transitions of care program for patients discharged from the emergency department

• Published in: JAACP : Journal of the American College of Clinical Pharmacy 2019-02, Vol.2 (1), p.8-13
• Main Authors: Lacy, Mary C., Bryant, Ginelle A., Herring, Morgan S., Koenigsfeld, Carrie F., Lehman, Nicholas P., Smith, Hayden L.
• Format: Article
• Language: English
• Subjects: ambulatory care; continuity of patient care; emergency medicine; medication reconciliation; pharmacists; prescriptions
• ISSN: 2574-9870; 2574-9870
• DOI: 10.1002/jac5.1011

Purpose To evaluate a pharmacy‐driven post‐emergency department (ED) transitions of care program. Methods Patients admitted to the ED who receive primary care at a network clinic were eligible for inclusion. Pharmacy team members contacted patients within 7 days of ED discharge to perform medication reconciliation and assess for appropriate follow‐up. Following the calling period, rates of repeat ED visits, urgent care visits, hospitalizations, and clinic visits within 30 days of ED discharge were evaluated. Results Seventy percent of eligible patients were successfully contacted via phone. At least one new medication was prescribed in the ED to 61% of contacted patients, 22% of which were not picked up at the time of the call. Medication reconciliation was successfully completed during 87% of the phone calls, with 64% resulting in at least one identified medication discrepancy. A total of 230 pharmacist interventions were completed. Contacted patients had an adjusted 44% (95% confidence interval [CI]: 9–65) lower risk of subsequent ED visits compared with patients unable to be reached. Four percent of patients successfully contacted were admitted to the hospital within 30 days of ED discharge compared with 8% of patients unable to be reached (adjusted relative risk [RR]: 0.39; 95% CI: 0.18–0.84). Conclusion Patients who received post‐ED transitions of care calls were less likely to be seen again in the ED or be admitted to the hospital within 30 days. Follow‐up phone calls provided by pharmacy team members may be an effective tool to improve transitions of care following ED visits.