Objectives: Surgical and medical ICU patients are at high risk of mortality and provide a significant cost to the healthcare system. The aim of this study is to describe the effect of pharmacist-led interventions on drug therapy and clinical strategies on ICU patient outcome and hospital costs.
Design: Before and after study in two French ICUs (16 and 10 beds).
Intervention: From January 1, 2013, to June 30, 2015, a pharmacist observation period was compared with an intervention period in which a critical care pharmacist provided recommendations to clinicians regarding sedative drugs and doses, choice of mechanical ventilation mode and related settings, antimicrobial de-escalation, and central venous and urinary catheters removal. Differences in ICU and hospital length of stay, duration of mechanical ventilation, mortality rate, and hospital costs per patient were quantified between groups with patients matched for severity of illness (Simplified Acute Physiology Score II) at admission.
Measurements and Main Results: From the 1,519 and 1,268 admitted patients during the observation and intervention periods, respectively, 1,164 patients were evaluable in both groups after matching for Simplified Acute Physiology Score II score. The intervention period was associated with mean (95% CI) reductions in patient hospital length of stay (3.7 d [5.2–2.3 d]; p < 0.001), ICU length of stay (1.4 d [2.3–0.5 d]; p < 0.005), duration of mechanical ventilation (1.2 d [2.1–0.3 d]; p < 0.01), and hospital costs per stay (2,560 euros [3,728–1,392 euros]; p < 0.001). The overall cost savings were 10,840 euros (10,727–10,952 euros) per month, mostly due to reduced consumption of sedatives and antimicrobials. No impact on mortality rate was identified.
Conclusions: Critical care pharmacist-led interventions were associated with decreases in ICU and hospital length of stays and ICU drug costs.
1Department of Clinical Pharmacy, Nîmes University Hospital, Nîmes, France.
2Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, Montpellier University, Montpellier, France.
3Intensive Care Unit, Division of Anesthesia Intensive Care Pain and Emergency, Nîmes University Hospital, Nîmes, France.
4EA 2992, Faculty of Medicine, Montpellier-Nimes University, Nîmes, France.
5Department of Microbiology, Nîmes University Hospital, Nîmes, France.
6INSERM, U1047, University of Montpellier, Nîmes, France.
7Royal Brisbane and Womens' Hospital, Brisbane, QLD, Australia.
8University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
9Centre for Translational Anti-infective Pharmacodynamics School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
Dr. Leguelinel-Blache participated in the design of the study protocol, analyzed the results, wrote the article, and answered the questions asked by the reviewers. Dr. Nguyen performed the statistical analysis, participated to the methodological redaction, and answer the methodological questions. Dr. Louart contributed to the statistical analysis and reviewed the article. Dr. Poujol performed the intervention, performed the data collection, and reviewed the article. Dr. Lavigne performed the bacteriologic data collection, wrote the bacteriologic results, and reviewed the article. Dr. Roberts participated in the design of the study protocol and critically reviewed the article. Dr. Muller participated in the design of the study protocol and critically reviewed the article. Dr. Kinowski participated in the design of the study protocol and critically reviewed the article. Dr. Roger participated to the design of the study protocol and critically reviewed the article. Dr. Lefrant coordinated the study, participated in the design of the study protocol, analyzed the results, wrote the article, and answered the questions asked by the reviewers.
Supported, in part, by institutional sources.
Dr. Roberts' institution received funding from Cardeas Pharma (investigator initiated grant) and MSD (investigator initiated grant and consultancy), he received funding for consulting from Astellas and BioMerieux, and he wishes to recognize funding from the Australian National Health and Medical Research Council for Centre of Research Excellence (APP1099452) and a Practitioner Fellowship (APP1117065). The remaining authors have disclosed that they do not have any potential conflicts of interest.
Critical Care Medicine46(2):199-207, February 2018.