Integrating the Clinical Pharmacists Into Emergency Department Teams

Summary

The "Emergency Department (ED) Pharmacist" is an integrated part of the ED interdisciplinary team in many countries, which have shown to improve medication safety and reduce costs related to hospitalisations. In Norway, few EDs are equipped with an ED pharmacist, and research describing effects on patients has not been conducted.

This is a multicentre study where the intervention will be implemented in the regular operation of three EDs in Northern Norway; Tromsø, Bodø and Harstad.

Clinical pharmacists will work as an integrated part of the ED team, and provide pharmaceutical care services such as medication reconciliation, medication review or medication counselling. The medical condition and complexity of the patient's disease will influence the extend and type of service from the pharmacist.

A non-randomized stepped wedge study design will be applied, where the ED pharmacist will be implemented in all three EDs after a three, six- and nine- month control period, respectively. Each ED will consequently have both intervention and control periods.

All patients going through the three EDs during the 12-month study period will be included. Patients admitted in the control periods will be allocated to the control group, while patients admitted in the intervention periods will be allocated to the intervention group.

The primary endpoint is "Time in hospital during 30 days after admission to the ED", which is a composite endpoint combining i) time in ED during stay, ii) time in hospital during stay if hospitalized and iii) time in urgent care clinic, ED and/or hospital if rehospitalized within 30 days after admission to ED Secondary endpoints include time to rehospitalization, length of stay (LOS) during first hospitalisation, LOS in EDs, rehospitalisation rates and mortality rates.

Patient data will be collected retrospectively from national data registries, from the hospital system and from patient records.

The Regional Committee for Medical and Health Research Ethics and Local Patient Protection Officers in all hospitals have approved the study.

Conditions

• Emergency Department
• Clinical Pharmacist

Interventions

OTHER

Introducing clinical pharmacists to the interdisciplinary ED team.

There will be two shifts, one shift from 08.00 - 15.00 and one from 12.00 - 19.00. Consequently, the hours of the day when the majority of patients arrives, are covered and the pharmacist capacity is doubled during the busiest time of the day. Early mornings are normally relatively slowed paced and the pharmacist may use this time to follow up on patients admitted during the night (from 19.00 - 08.00), in particularly those who have been admitted to wards without an assigned pharmacist.

Sponsors & Collaborators

• University Hospital of North Norway

  collaborator OTHER

• Nordlandssykehuset HF

  collaborator OTHER

• The Royal Norwegian Ministry of Health

  collaborator OTHER

• University of Tromso

  collaborator OTHER

• Hospital Pharmacy of North Norway Trust

  lead OTHER

Principal Investigators

• Renate Elenjord, PhD · Hospital Pharmacy of North Norway Trust

Study Design

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SEQUENTIAL

Eligibility

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-02-01

Primary Completion

2023-12-31

Completion

2025-12-31

Countries

• Norway

Study Locations