Cost avoidance associated with clinical pharmacist presence in a medical intensive care unit

Abstract

ObjectiveTo determine the clinical pharmacist‐generated cost avoidance and benefit‐cost ratio in a medical intensive care unit (MICU).MethodsAll accepted clinical pharmacist recommendations on a multidisciplinary, rounding service at an academic medical center over a 12‐month period were evaluated. Cost avoidance values from each intervention were determined using a systematic framework. Total cost avoidance was calculated by summing the cost avoidance for each general category. Average rates of cost avoidance per day and hour were calculated by dividing total cost avoidance by number of days and hours the clinical pharmacist provided care. Average interventions and cost avoidance per day and hour were calculated for weekday and call status. Differences between months, day of the week, and call status were evaluated using chi‐square goodness of fit tests.ResultsOver 12 months, 8866 clinical pharmacist‐recommended interventions were implemented, averaging 38.9 interventions per workday. The four most commonly accepted interventions were minor adverse drug event prevention (n = 4023, 45%), dosage adjustment: no continuous renal replacement therapy (n = 1162, 13%), antimicrobial therapy initiation and streamlining (n = 966, 11%), and antimicrobial pharmacokinetic evaluation (n = 777, 9%). All interventions resulted in a total cost avoidance of $3 270 178, averaging $14 731 per workday. Interventions per hour (P < 0.001) and average cost avoidance per hour (P < 0.001) differed significantly across workdays. For on‐call days compared with postcall days, there were a similar average number of interventions per hour (10.2 vs 9.8, P = 0.28) and average cost avoidance per hour ($3741 vs $3622, P = 0.47); the benefit‐cost ratio was 24.5:1.ConclusionsThe clinical pharmacist‐generated cost avoidance over a 12‐month period in the MICU was $3 270 178 and the benefit‐cost ratio was 24.5:1. Day of the week but no call status affected average cost avoidance. Employing a clinical pharmacist to be part of the multidisciplinary MICU team can reduce health care expenditures through cost avoidance.