Hospital Pharmacy - May 2017 - 351

351

Aniemeke et al.
Table 2. Outcome Analysis.
Outcomes
3-day readmissions
30-day readmissions
3-day ED visits
30-day ED visits
Median days to first readmission
or ED visit, n (range)

Study group (n = 44)

Control group (n = 45)

P value

4.6%
18.2%
0%
4.6%
22 (4-30)

6.7%
26.7%
6.7%
11.1%
12 (4-20)

1.0
.45
.24
.43
.26

Note. ED = emergency department.

patients who received discharge medication counseling.
Pharmacists in both studies provided discharge medication
reconciliation and discharge medication instructions.
Evaluation of baseline characteristics in this study indicated
that the control and study groups were similar. No statistically significant difference was observed in the admission
diagnosis, ethnicity, primary language, length of stay, or
payor between groups, indicating less confounding baseline
variables that may have increased the chance of hospital
readmission. There was also no difference observed in the
number of discharge medications between control and study
groups, which eliminated the chance that one group was
more at risk for a medication-related events than the other.
This study demonstrated that the discharge medication
counseling service had an effect in reducing overall cumulative numbers of readmissions and ED visits, while increasing
the numbers of days from discharge to first readmission or
ED visit in patients deemed high risk for readmission.
None of the patients from the study group returned to the
ED within 3 days of discharge compared with the control
group, which had a 6.7% ED return rate. A greater than
2-fold increase in 30-day ED visits post discharge was seen
in the control group compared with the study group. The
duration of time (days) post discharge that it took high-risk
patients to present to the ED or be readmitted the hospital
was twice as long in the study group compared with the control group. These results indicate a possible correlation
between medication-related problems in high-risk patients
and readmission rates, unplanned ED visits, and number of
days to first readmission or ED visit.
This study was not without limitations. Given that it was
a retrospective review, confounding variables and potential
bias that could not be controlled may have occurred. Also,
the 3-month duration of the study yielded a relatively small
sample size, and therefore, this study was underpowered to
show a significant difference in the primary outcome. A
larger sample size may have provided a more comprehensive
assessment of the effectiveness of the discharge counseling
service. Patients were defined as high risk if they were calculated to have at least a 48.3% likelihood of being readmitted
within 30 days according to the PIECES software program.
However, the control group in this study had a lower than
expected 30-day readmission rate (26.7%), which may have
contributed to the lack of a statistically significant difference

between groups. The lower than expected 30-day readmission rate in the control group may have been attributed to
other ongoing transition of care initiatives at the health system. These included a transition of care team comprised of a
nurse case manager, social worker, and transition of care
navigator that met daily to discuss discharge plans, funding
source, and follow-up appointments and conduct postdischarge follow-up by phone for patients at high risk for 30-day
readmission. It is likely that services provided by this team
would have impacted both study and control groups in a similar fashion, because that initiative commenced prior to the
start of our research and both groups included in our study
were comprised of high-risk patients admitted to the same
hospital unit. Postdischarge follow-up by a pharmacist was
not incorporated into the pharmacy discharge counseling service due to lack of resources at the time; this may have also
lead to a larger difference in outcomes between groups.
Disposition of patients post discharge and admissions and
ED visits to facilities outside of the health system were not
accounted for in this study. This may have affected the readmission rates and ED visits reported in the study.
A major strength of the study was the availability of a
validated customizable risk stratification tool, PIECES. The
software helped identify patients who were high risk for
readmission based on International Classification of
Diseases, Ninth Revision (ICD-9) codes, procedure codes,
lab values, and socioeconomic data. Readmission risk classifications in PIECES could be modified to identify patients
with an even greater risk, which may have resulted in significant differences between groups. Other strengths include
well-matched patient groups as previously mentioned and
consistency in the discharge counseling provided, with one
pharmacist conducting most of the education.

Conclusion
Discharge medication counseling provided by a clinical
pharmacist to patients who were at high risk for readmission
was associated with reduced 3-day and 30-day readmission
rates and ED visits and an increased number of days to first
readmission or ED visit. Although no statistical difference
was found between groups, integration of a clinical pharmacist as part of the discharge medication process resulted in
numerical improvements in all 3 major outcomes. Additional



Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
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Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
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