Background: A number of patient safety and transition of care initiatives have highlighted the benefits of incorporating a clinical pharmacist in the discharge medication process. Numerous studies have identified the prominent and consequential role of medication therapy errors occurring at hospital discharge. Objective: The objective of this study was to evaluate the effects of a discharge medication counseling service on readmission rates, emergency department (ED) visits, and days to first readmission or ED visit in patients deemed high risk for hospital readmission. Methods: A retrospective chart review was conducted from October 2014 to December 2014 in adult patients admitted to a general medicine unit and identified as being at high risk for readmission. Endpoints were compared between patients who received discharge counseling (study group) and those who did not (control group). Results: Eighty-nine high-risk patient charts were reviewed. Forty-four patients were in the study group and 45 patients were in the control group. There were no differences between the baseline characteristics of both groups. There were no differences between the study and control groups in 30-day readmission rates (18.2% vs 26.7%; P = .45) and in 30-day ED visits (4.6% vs 11.1%; P = .43). The number of days to first readmission or ED visit between the study and control groups was 22 versus 12 (P = .26). Conclusion: Although no statistical difference was found between groups in this study, integration of a clinical pharmacist as part of an interdisciplinary approach in the discharge medication process resulted in numerical improvements in outcomes. Additional investigation is warranted to further highlight the potential benefits of this service.
Keywords: discharge counseling; hospital readmissions; pharmacist.