It might not be feasible to hire clinical pharmacists to be solely assigned to hospitalist teams, although success has been found at Mercy through the development of a shared clinical position with the College of Pharmacy. Although described as a 50-50 position, a majority of the teaching duties occur on-site at Mercy, working with fourth-year pharmacy students on clinical rotations. It has become a win-win situation: The hospitalist team benefits from a dedicated clinical pharmacist, and the students benefit from a clinical setting with vast opportunities to review general internal-medicine cases.
In contrast to developing a new position, reallocation of resources often is the route by which collaborations evolve. In a 2005 article by Cohen et al at Brookhaven Memorial Hospital in Patchogue, N.Y., patients treated by voluntary attending physicians were compared with patients treated by hospitalists who collaborated with residents from the institution’s accredited pharmacy residency program. Analyses revealed the hospitalist/pharmacist group achieved a 23% shorter length of stay, 21% lower cost of medication, and 1.5 fewer medications per patient.2 The hospitalist/pharmacist group also had a reduced length of IV antibiotic therapy and gastrointestinal medications by 1.7 and 0.9 days, respectively.2
Although anecdotal, an added benefit to having a clinical pharmacist assigned to the HM team at Mercy is continuity and familiarity with the physicians and patients. The clinical pharmacist inherently has a vested interest in the success of the hospitalists as well as the pharmacy department, which provides ongoing momentum for joint projects.
The recent development of the HM model of inpatient care has coincided with a rapid evolution in the role of hospital-based clinical pharmacists. Pharmacologic interventions are utilized for virtually all hospitalized patients, and they are inherently complex and potentially hazardous. Pharmacist involvement with the multidisciplinary hospitalist team provides a mechanism to address and minimize these complexities.
Innovative approaches to reallocate or create collaborative models are needed as the two disciplines, hospitalists and clinical pharmacists, continue to transform inpatient care.
Phyllis Hemerson, PharmD, BCPS
clinical pharmacy specialist
Mercy Hospital, Iowa City
assistant professor, University of Iowa College of Pharmacy
Martin Izakovic, MD, PhD, CPE, FHM, FACP, FACPE
vice president of medical staff affairs and chief medical officer
hospitalist program medical director, Mercy Hospital
References
- Cobaugh DJ, Amin A, Bookwalter T, et al. ASHP-SHM Joint Statement on Hospitalist-Pharmacist Collaboration. Am J Health Syst Pharm. 2008;65(3):260-263.
- Cohen K, Syed S. Hospitalists, pharmacists partner to cut errors. Healthcare Benchmarks Qual Improv. 2005;12(2):18-19.