PCAT Location

In organizations with plenty of empty bed capacity and no delays in bed assignment or transfer of patients from the ED to hospital beds, a roving team should be able to provide the PCAT assessment on the unit. High volume, capacity constricted hospitals, with extended boarder hours in the Emergency Department and delays in patient flow will require an ED-based model. This allows for the process to initiate immediately once the decision to hospitalize an ED patient has been made.

Real-World Impact

In a PCAT system, care delivery begins immediately following the request for hospitalization. This is extremely important in many disease processes that demand ongoing aggressive care. Patients awaiting admission can deteriorate, resulting in longer lengths of stay, increased complications, and increased costs, aside from the obvious increase in danger and discomfort to the patient. Congestive Heart Failure (CHF), Chronic Obstructive Pulimonary Disease (COPD), asthma, dehydration, hyper- or hypoglycemia, and urgent hypertension are just a few examples of conditions requiring speedy admission and immediate care.

PCAT patients also move through the complex hospital system more smoothly and efficiently. They already have a full nursing assessment and their initial medications when they arrive on the hospital floor, which has several key benefits. Floor nurses need not be pulled for extensive periods from other patients, and there is far less chance for medication error. The long wait times for drugs to be delivered are heavily reduced. A recent study, excerpted below with the author’s permission, provides excellent data on the impact of a PCAT implementation in practice.

Abstract PCAT: Value of a Decentralized Pharmacist in a Multidisciplinary and Patient-Centered Team in Improving Patient Flow in the Hospital

Patnawon Thung, PharmD (Tables 11.1 and 11.2)

Table 11.1 Primary Impact 1—Reduction in Processing Time from Admission to MAR Completion: 190 Cases

Table 11.2 Primary Impact 2—Accuracy of Medication—Use of a Pharmacist in Completing Medication Reconciliation at the Time of Admission Results in Significant Interventions and Is Able to Identify Medication List Errors Patients Carry on a Regular Basis. Accuracy of Medication/Reconciliation of Medications at the Time of Admission for 190 Cases over 9 Weeks

Table 11.3 Primary Impact 3—Pharmacy Intervention in Drug Information, Drug Interaction, Dosage Adjustments, Pharmacokinetics, Substitutions, and Over Volume of Orders Entered per Week

To shed some light on what these numbers really mean, consider just the 94 medication corrections that were made at the time of the PCAT team evaluation. Under standard circumstances, this would have resulted in 94 phone calls being made by the pharmacist to the provider to correct the medication error. That is a lot of provider time if you consider a phone call to be even 1 min, and that every call was answered immediately. That is over 1.5 h correcting medications. Time that could be spent caring for patients. This clearly demonstrates the significant impact a pharmacist can have on medication reconciliation at the time of admission (Table 11.3).

These types of interventions are not only cost effective but profoundly impact patient safety and proper drug utilization. This also demonstrates how workloads are rebalanced. With these orders and interventions now being carried out at the bedside by a pharmacist in real time, the workload of the central pharmacist, who previously performed these tasks in a central pharmacy, is decreased. Moving these tasks to the bedside is clearly safer for the patient, and is more cost-efficient for the hospital, too.

Secondary impacts were found to be significant when comparing PCAT patients to the same patient types admitted by the pre-PCAT methodology (Table 11.4).

Table 11.4 Secondary Impact 1—Length of Stay

Table 11.5 Secondary Impact 2—30-Day Readmission Reduction

This finding supports the theory that providing care to patients more quickly results in more rapid recovery and an earlier discharge. Patients with many disease processes such as asthma, congestive heart failure, and hyperglycemia require aggressive initial therapy and uninterrupted treatment, even as they move through the system. Patients with co-morbid conditions such as hypertension or diabetes require regular medication, or else they may experience worsening of their untreated co-morbid condition. These types of cases are reflected in this data (Table 11.5).

Simply by performing medication reconciliation up front and instituting more aggressive therapy, there was an expectation that the 30-day readmission for patients treated by the PCAT would be lower than their matched baseline comparisons. The results were astounding. Cutting these readmissions by almost half has an enormous impact on the hospital’s reimbursement for services, not to mention patient satisfaction, and, ultimately, patient outcomes.

The PCAT system has a profound impact on organizational efficiency and patient care. There really is no good reason not to do this in every hospital. Also, elements of the PCAT system could be adapted to surgical cases to reduce errors, improve patient management and enhance medication reconciliation—all areas which need improvement.