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Pharmacist-Led Discharge Clinic Helps Chicago Hospital Cut Readmission Rates

Medication management issues are among primary causes of preventable return visits

A discharge clinic, staffed with a pharmacist and a nurse practitioner who meet with patients after their release from the hospital, has helped Mercy Hospital & Medical Center in Chicago slash its readmission rates, according to an article on the Hospitals and Health Networks Daily website.

Many of the patients that Mercy admits are high-risk patients, so they are in jeopardy of being readmitted after discharge, the article says. Recognizing that medication management issues tend to be one of the primary reasons behind preventable readmissions, hospital leaders turned to the pharmacy team to find a collaborative solution. The team is led by Comprehensive Pharmacy Services, which manages Mercy’s inpatient and outpatient pharmacy-related activities, 340B program, and pharmacy operations in several clinics and outpatient facilities.

The pharmacy leadership team recommended piloting a multidisciplinary discharge clinic housed at Mercy’s affiliate, the Mercy Family Health Center. The center is a community-based outpatient facility aligned with the hospital and staffed by clinicians who deliver wellness care to adults, infants, and children, and provide specialized services to seniors. It handles many of the more challenging cases, including patients with no primary care physician or insurance.

With the support of hospital administrators, the discharge clinic opened in October 2013. The initial plans were to operate the clinic as a pilot program and to evaluate its ability to prevent 30-day hospital readmissions and repeat emergency department visits.

Within the first month, readmissions of patients seen by the nurse practitioner decreased, and readmissions decreased even more significantly when the pharmacist and nurse practitioner saw patients together.

Mercy improved and sustained these results over the course of the first year of its discharge clinic’s operation:

  • In the first month, only 3% of at-risk patients seen by both the pharmacist and the nurse practitioner were readmitted within 30 days of discharge compared with 15% of post-discharge patients who were seen by the nurse practitioner alone.
  • By the end of the first quarter, the readmission rate for at-risk patients seen by both the pharmacist and the nurse practitioner dropped to 2% compared with 15% for at-risk patients seen only by the nurse practitioner.
  • In the following three quarters, none of the at-risk patients seen by both the pharmacist and nurse practitioner was readmitted, compared with 11%, 17%, and 8%, respectively, for the same periods for at-risk patients seen only by the nurse practitioner.
  • As a whole, the discharge clinic saw the readmission rates for all of its patients drop from 7% in its first quarter to 1% a year later.

The program has been so successful that Mercy has increased dedicated staff, expanded pharmacist availability to six half-days, and extended access to the discharge clinic to all patients discharged from the hospital.

Sources: FierceHealthcare; June 19, 2015; and H&HN; June 18, 2015.

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