Impact of quality bundle enforcement by a critical care pharmacist on patient outcome and costs

Géraldine Leguelinel-Blache; Tri Long Nguyen; Benjamin Louart; Hélène Poujol; Jean Philippe Lavigne; Jason A. Roberts; Laurent Muller; Jean Marie Kinowski; Claire Roger; Jean Yves Lefrant

doi:10.1097/CCM.0000000000002827

Impact of quality bundle enforcement by a critical care pharmacist on patient outcome and costs

Géraldine Leguelinel-Blache, Tri Long Nguyen, Benjamin Louart, Hélène Poujol, Jean Philippe Lavigne, Jason A. Roberts, Laurent Muller, Jean Marie Kinowski, Claire Roger, Jean Yves Lefrant^*

^*Corresponding author for this work

28 Citations (Scopus)

Abstract

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 pharmacistled 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). Patients: ICU patients. 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. (Crit Care Med 2018; 46:199-207).

Original language	English
Journal	Critical Care Medicine
Volume	46
Issue number	2
Pages (from-to)	199-207
Number of pages	9
ISSN	0090-3493
DOIs	https://doi.org/10.1097/CCM.0000000000002827
Publication status	Published - 2018
Externally published	Yes

Keywords

Antibiotic
Clinical pharmacy
Cost expenditure
Intensive care unit
Sedation

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10.1097/CCM.0000000000002827

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@article{b6597c39182046e5bc67daf964a7102f,

title = "Impact of quality bundle enforcement by a critical care pharmacist on patient outcome and costs",

abstract = "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 pharmacistled 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). Patients: ICU patients. 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. (Crit Care Med 2018; 46:199-207).",

keywords = "Antibiotic, Clinical pharmacy, Cost expenditure, Intensive care unit, Sedation",

author = "G{\'e}raldine Leguelinel-Blache and Nguyen, {Tri Long} and Benjamin Louart and H{\'e}l{\`e}ne Poujol and Lavigne, {Jean Philippe} and Roberts, {Jason A.} and Laurent Muller and Kinowski, {Jean Marie} and Claire Roger and Lefrant, {Jean Yves}",

year = "2018",

doi = "10.1097/CCM.0000000000002827",

language = "English",

volume = "46",

pages = "199--207",

journal = "Critical Care Medicine",

issn = "0090-3493",

publisher = "Williams & Wilkins",

number = "2",

}

TY - JOUR

T1 - Impact of quality bundle enforcement by a critical care pharmacist on patient outcome and costs

AU - Leguelinel-Blache, Géraldine

AU - Nguyen, Tri Long

AU - Louart, Benjamin

AU - Poujol, Hélène

AU - Lavigne, Jean Philippe

AU - Roberts, Jason A.

AU - Muller, Laurent

AU - Kinowski, Jean Marie

AU - Roger, Claire

AU - Lefrant, Jean Yves

PY - 2018

Y1 - 2018

N2 - 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 pharmacistled 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). Patients: ICU patients. 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. (Crit Care Med 2018; 46:199-207).

AB - 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 pharmacistled 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). Patients: ICU patients. 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. (Crit Care Med 2018; 46:199-207).

KW - Antibiotic

KW - Clinical pharmacy

KW - Cost expenditure

KW - Intensive care unit

KW - Sedation

U2 - 10.1097/CCM.0000000000002827

DO - 10.1097/CCM.0000000000002827

M3 - Journal article

C2 - 29189346

AN - SCOPUS:85047753212

SN - 0090-3493

VL - 46

SP - 199

EP - 207

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 2

ER -

Impact of quality bundle enforcement by a critical care pharmacist on patient outcome and costs

Abstract

Keywords

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