Maximizing Acceptance of Clinical Pharmacy Recommendations May Reduce The Length of Hospital Stay in A Private Hospital From Amman, Jordan: Toward Fully Independent Pharmacist Prescribers
Abstract Background: Clinical pharmacy interventions (CPI) usually require prior medical authorization with 20% being rejected. If pharmacists prove to be more competent in this area (accept 100% of CPI), the profession will step closer to a fully-independent prescriber status. Objective: This study use an artificial neural network (ANN) model to determine whether clinical pharmacy (CP) may improve outcomes associated with rejected CPI. Setting: This is a non-interventional, retrospective analysis of documented CPI in a 100-bed, acute-care private hospital in Amman, Jordan.Method: Study consists of 542 patients, 574 admissions, and 1694 CPI. Team collected demographic and clinical data using a standardized tool. Input consisted of 54 variables with some taking merely repetitive values for each CPI in a given patient whereas others varying with every CPI. Therefore, CPI was consolidated to one rejected and/or one accepted per patient per admission. Groups of accepted and rejected CPI were compared with matched and unmatched variables. ANN were, subsequently, trained and internally as well as cross validated for outcomes of interest. Outcomes were length of hospital and intensive care stay after the index CPI (LOSTA & LOSICUA, respectively), readmissions, mortality, and cost of hospitalization. Best models were finally used to compare the two scenarios of approving 80% versus 100% of CPI. Variable impacts (VI) automatically generated by the ANN were compared to evaluate the effect of rejecting CPI. Main outcome measure: Lengths of hospital stay after the index CPI (LOSTA).Results: ANN configurations converged within 18 seconds and 300 trials. All models showed a significant reduction in LOSTA with 100% versus 80% accepted CPI of about 0.4 days (2.6 ± 3.4, median (range) of 2 (0 – 28) versus 3.0 ± 3.8, 2 (0 – 30), P-value = 0.022). Average savings with acceptance of those rejected CPI was 55 JD (~ 78 US dollars) and could help hire about 1.3 extra clinical pharmacist full-time equivalents. Conclusion: Maximizing acceptance of CPI reduces the length of hospital stay in this model. Pharmacists seem to be well-positioned to target gain the upper hand on prescribing in these situations.