Pharmacists in ED Deliver Drugs More Quickly | News | Loyola Medicine
Friday, September 6, 2019

Patients Receive Critical Drug More Quickly When Pharmacists Are in the Emergency Department

Pharmacist using a tablet in emergency room.

MAYWOOD, IL – Millions of patients take blood thinners such as Coumadin to prevent blood clots that can cause strokes.

But when such patients come to the emergency department (ED) with life-threatening bleeding, they may require a drug that counteracts the effect of blood thinners, thereby improving coagulation.

Now a first-of-its-kind study by Loyola Medicine researchers has found that when a pharmacist is present in the ED, patients receive the coagulation drug much more quickly, resulting in less time in the intensive care unit and shorter hospital stays. (The coagulation drug is called four-factor prothrombin complex concentrate or 4F-PCC.)

The retrospective study by first author Dalila Masic, PharmD, senior author Megan A Rech, PharmD, MS, BCPS, BCCCP, and colleagues is published in the Journal of Emergency Medicine.

The study included 116 patients who were on a blood thinner and came to the ED with life-threatening bleeding. The most common blood thinner was warfarin (brand name Coumadin), and the most common indication for the blood thinner was treatment of a heart rhythm disorder called atrial fibrillation. The most common type of bleeding was intracranial hemorrhage (bleeding inside the skull that causes a stroke).

Of the 116 patients, 50 had a clinical pharmacist at their bedsides and 66 had a physician team alone. (A clinical pharmacist is typically present in Loyola's ED during weekdays but not during nights and weekends.)

Among patients who had a pharmacist at the bedside managing medications, the coagulation drug was administered in a median time of 66.5 minutes, compared with 206.5 minutes in patients without a bedside pharmacist. Patients with a bedside pharmacist spent less time in the intensive care unit (2 days vs. 5 days) and in the hospital overall (5.5 days vs. 8 days).

The study findings suggest that bedside pharmacists helped emergency physicians in clinical decision-making and appropriate ordering of 4F-PCC. Pharmacists communicated with the central pharmacy to ensure the life-saving medication was delivered to the patient in a timelier manner.

"A clinical pharmacist provides valuable therapeutic recommendations and optimizes time to receipt of life-saving pharmacotherapy," researchers concluded.

The study is titled "Pharmacist presence decreases time to prothrombin complex concentrate in emergency department patients with life-threatening bleeding and urgent procedures."

In addition to Drs. Masic and Rech, other co-authors, all at Loyola, are Daniel Colon Hildalgo, MD, Shannon Kuhrau, PharmD and Whitney Chaney, PharmD, BCPS, BCCCP.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.