PHarmacist avoidance or reductions in medical costs in CRITically ill adults rounding with one SERVICE compared to two or more services: PHARM-CRIT-SERVICE

Introduction: Intensive care unit (ICU) pharmacists are integral members of the interdisciplinary health care team. Pharmacy staffing models vary by ICU and hospital, and clinical pharmacists may cover one ICU service or multiple services. It is presently unknown how covering or rounding on multiple services relative to one service impacts the quantity of interventions made or the acceptance rate of those interventions. Methods: Exploratory analysis of the PHarmacist Avoidance or Reductions in Medical costs in CRITically ill adults (PHARM-CRIT) study, a multicenter, prospective, observational study was performed between August 2018 and January 2019 in academic medical centers and community hospitals throughout the United States. ICU pharmacists documented recommendations and accepted interventions. Pharmacists that covered one service were compared to those who covered two or more services or no services. Results: 218 ICU pharmacists participated across 85 centers. There were 2905 shifts and the primary rounding structure was one service (n = 1766, 60.8%) compared to covering two or more services (n = 822, 28.3%), and no rounding (n = 317, 10.9%). The percent of pharmacists with accepted interventions was higher with one service compared to the other groups: one service (45.7% ± 1.8) vs. no rounding (12.7% ± 1) (odds ratio [OR] 4.92 [95% confidence interval (CI) 4.19–5.78]) and one service vs. two or more services (31.6% ± 1.6) (OR 1.81 [95% CI 1.67–1.95]). This was also observed when comparing two or more services to no rounding (OR 2.73 [95% CI 2.32–3.2]). The probability of an intervention being accepted was highest in pharmacists rounding on one service, followed by two or more services, and least likely without rounding. Increasing the patient load of the pharmacist in any of the rounding structures resulted in a decline in interventions being accepted. Conclusions: ICU pharmacists rounding with one service relative to two or more or none had more interventions attempted and accepted.