Effect of Clinical Pharmacists on Care in the Emergency Department: a Systematic Review

Purpose: A systematic literature review was conducted to ascertain the scope of involvement of clinical pharmacists in the emergency department (ED); summarize economic, humanistic, and clinical outcomes data; describe current limitations of these data; and identify areas for future research.

Methods: A search of MEDLINE, The Cochrane Library, International Pharmaceutical Abstracts, and CINAHL Plus databases was conducted. Articles were included in this review if the title and abstract indicated that the article's content addressed the scope of involvement of pharmacists in the ED or pharmacist interventions in the ED and their associated outcomes, such as humanistic outcomes, cost avoidance, or improved quality. Qualitative analyses were conducted to characterize pharmacists' activities and effects in the ED.

Results: Of the 533 returned citations, only 17 met the inclusion criteria. Each provided a description of clinical pharmacy services at 12 different institutions. Descriptions of these institutions and job responsibilities of the ED pharmacists are described. Six studies reported information about pharmacist interventions, including the number and types of interventions, time spent per intervention, and acceptance rate of interventions. Four studies reported cost-related outcomes data.

Conclusion: A review of the literature revealed that pharmacists have been involved in the ED for decades. Services provided by pharmacists in the ED included traditional clinical pharmacy services, responding to medical emergencies, providing consultations on medication issues, identifying and reducing medication errors, and conducting medication histories at hospital admission. Some services were shown to be cost saving or cost avoiding.