Integrating the clinical pharmacist into the emergency department interdisciplinary team: a study protocol for a multicentre trial applying a non-randomised stepped-wedge study design

Abstract

Introduction: The 'emergency department (ED) pharmacist' is an integrated part of the ED interdisciplinary team in many countries, which have shown to improve medication safety and reduce costs related to hospitalisations. In Norway, few EDs are equipped with ED pharmacists, and research describing effects on patients has not been conducted. The aim of this study is to investigate the impact of introducing clinical pharmacists to the interdisciplinary ED team. In this multicentre study, the intervention will be pragmatically implemented in the regular operation of three EDs in Northern Norway; Tromsø, Bodø and Harstad. Clinical pharmacists will work as an integrated part of the ED team, providing pharmaceutical care services such as medication reconciliation, review and/or counselling. The primary endpoint is 'time in hospital during 30 days after admission to the ED', combining (1) time in ED, (2) time in hospital (if hospitalised) and (3) time in ED and/or hospital if re-hospitalised during 30 days after admission. Secondary endpoints include time to rehospitalisation, length of stay in ED and hospital and rehospitalisation and mortality rates.

Methods and analysis: We will apply a non-randomised stepped-wedge study design, where we in a staggered way implement the ED pharmacists in all three EDs after a 3, 6 and 9 months control period, respectively. We will include all patients going through the three EDs during the 12-month study period. Patient data will be collected retrospectively from national data registries, the hospital system and from patient records.

Ethics and dissemination: The Regional Committee for Medical and Health Research Ethics and Local Patient Protection Officers in all hospitals have approved the study. Patients will be informed about the ongoing study on a general basis with ads on posters and flyers.

Trial registration number: NCT04722588.

Keywords: accident & emergency medicine; clinical pharmacology; health & safety; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

The stepped-wedge study design showing the distribution of control (C) and the intervention (I) periods during a 12-month study period.

Figure 2

Flow chart of the anticipated population presenting to the emergency departments during the study period.

Figure 3

A pharmacist intervention in the emergency department (ED) put in the perspective of the ED patient flow.

Figure 4

A graphical representation of the inclusion and exclusion of stays. Patient X is admitted on day 1 and stays in the hospital for 5 days (first box). The patient then gets admitted again on day 18 (second box) for another 7 days. These 7-day count towards the primary endpoint during the 30-day time window after the first admission. However, to avoid double-counting time, the second admission is excluded as a separate stay. The third stay (third box) is an admission on day 49 and it is counted a new stay with its own 30 days.