First Author: Desiree E. Kosmisky, PharmD, BCCCP, FCCM Co-Author: Sonia Everhart, BCCCP, BCPS, PharmD – Atrium Health Co-Author: Lindsay K. Jones, PharmD, BCCCP, BCGP, BCPS – Clinical Pharmacy Specialist, Atrium Health Cabarrus Co-Author: Eric Drab, PharmD, BCPS, BCCCP – Clinical Pharmacist, Atrium Health Cabarrus
Introduction: To date, cost avoidance (CA) associated with critical care pharmacists has been documented primarily in traditional bedside settings, with only two studies evaluating CA in a telecritical care (TCC) setting. This quality improvement (QI) project seeks to determine the types of interventions made, CA, and return on investment (ROI) of TCC pharmacy services covering 91 ICU beds at 8 facilities within a large healthcare system.
Methods: This was a retrospective, multicenter, observational QI project categorizing accepted interventions performed by TCC pharmacists in 2024 working 8-hour dayshifts Monday through Friday and calculating associated CA and ROI using American Society of Health-System Pharmacists standards. The primary outcomes include quantity and type of interventions documented plus CA and ROI, with a sensitivity analysis performed to account for the probability that 25 to 75% of interventions may have occurred without the presence of the TCC pharmacist. Secondary outcomes included CA calculated by facility and by medication class. Descriptive statistics were reported.
Results: A total of 3084 interventions were performed in 1244 patients across 251 shifts, an average of 12.3 interventions per shift. Gross cost avoidance was calculated as $1,747,779 in 2024 USD with an adjusted CA range of $227,125 to $1,101,014. One rural 18-bed ICU accounted for 38.3% of CA, an 8-bed urban ICU accounted for 20.1% of CA, and a rural 10-bed ICU accounted for 19.9% of CA. The most common medication classes included agents for glycemic control (15.1%), pain, agitation, and delirium (13%), antimicrobials (12.9%), and stress ulcer prophylaxis (11.3%). CA was driven primarily by adverse drug event prevention, accounting for 444 interventions (213 major and 191 minor) and $980,705 in cost savings. Overall ROI was 8.3:1, with an adjusted range of 2.1:1 to 6.3:1.
Conclusions: CA reported by TCC pharmacists was aligned with published literature estimates of CA in traditional bedside settings and associated with a positive ROI. TCC pharmacy services are a cost-effective way to extend critical care pharmacy services to facilities within a healthcare system without these resources.
