Involving clinical pharmacists in the direct care of intensive care unit (ICU) patients with thromboemobolic or infarction-related events (TIE) was associated with reduced mortality, improved clinical and charge outcomes, and fewer bleeding complications, according to MacLaren and Bond.1
The authors used the results of a national survey describing clinical pharmacy services in ICUs together with data from MedPAR. MedPAR data were abstracted to identify TIE patients using ICD-9-DM
codes and clinical and economic outcomes, including mortality, lengths of ICU stay, and Medicare charges. Aggregated outcomes of hospitals with TIE ICU services (n = 158) were compared with those without ICU services (n = 134), representing 77,857 and 63,222 patients, respectively. Mortality rates among patients with (31%) and without (37%) bleeding complications were higher without ICU services. Similarly, lengths of stay were longer, total Medicare, drug, and laboratory charges were higher without ICU services. Bleeding complications and receipt of transfusions and blood products occurred more often.
Implications. This study demonstrates the use of automated databases versus randomized clinical trials for comparative effectiveness of clinical specialist versus nonspecialist ICU services. Although subject to the limitations of retrospective studies, these studies are conducted at considerably lower cost, make more efficient use of resources, and can be generalized beyond a single hospital with a single pharmacist.