Background: Institutions providing total joint arthroplasty (TJA) procedures are subject to substantial outcomes reporting, including those influencing payment for services. Although clinical pharmacists are well-poised to add value, a comprehensive approach to optimizing pharmacotherapy across the care continuum for TJA patients has not been described.
Methods: This prospective, interventional, sequential cohort study was approved by our Institutional Review Board. The objective was to assess the impact of an Orthopedic Clinical Pharmacist service on institutional TJA complication rates and costs. Outcomes were compared for a Baseline period of July 2015 to February 2016 and a Post-implementation period of September 2016 to February 2017, allowing for a 6-month run-in period. Additionally, we pursued a post-discharge, RN-administered patient survey and an exploratory economic assessment.
Results: A total of 1715 TJA procedures were performed at the institution during the 20-month study timeframe. Postoperative readmission rate (1.3% vs 4.8%, P = .002) and complication rate (1.8% vs 3.4%, P = .760) were lower in the Post-implementation period. Postoperative VTE rate decreased to zero in the Post-implementation period (0.0% vs 0.6%, P = .13) and average hospital length of stay was unchanged (2.8 vs 2.9 days). Patient self-rated understanding of discharge medications was improved and satisfaction with pharmacist interaction was very high. The service conferred an estimated $73,410 net annual cost savings to the institution.
Conclusion: Integration of a clinical pharmacist service for TJA patients was associated with clinically meaningful improvements in institutional outcomes, likely conferring substantial cost-benefit.
Keywords: clinical pharmacy; quality measures; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty.
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