Interprofessional Collaboration between Physicians, Nurses, and Pharmacists Improves Medical and Economic Outcomes in an Intensive Care Unit with a Focus on Gastroenterology

ABSTRACT

Introduction: Since 2015, the medical intensive care unit (ICU) with a focus on gastroenterology of the Department of Internal Medicine 1 at the University Hospital Regensburg, Germany, has a particular emphasis on interprofessional collaboration with staff nurses and hospital pharmacists. The hospital pharmacists have access to the hospital information system and the electronic charting program. Consultations take place on daily basis. Furthermore, weekly joint rounds within the antibiotic stewardship program are performed. Furthermore, there is a joint training and teaching of medical, nursing and pharmacy students within the intensive care training ward Regensburg (I'M A-STAR project). Aims & Methods: The study aims to investigate to what extent the newly introduced structural changes affect clinical and economic outcomes. We examined clinical performance data and consumption figures for antibiotics and other drugs over a 10-year period from 2011 to 2021. Data from the hospital pharmacy, hospital administration, electronic charting, and hospital information systems were included in the analyses. An electronic platform was developed specifically to improve documentation. The years 2020 and 2021 were considered separately due to the COVID-19 pandemic and the care of numerous COVID-19 patients in the ICU. Result(s) It could be shown that the pharmacist's recommendations regarding drug administration were mainly related to indication (43.6%), dosage (27.6%), interactions (9.4%), and side effects (4.1%). Antibiotic consumption was reduced by 12.2% from 2015 to 2019. Encouragingly, this included a 23.4% reduction in carbapenem use. Antibiotic spending was reduced by 24.9% overall. An analysis of the intensive care G-DRGs showed that the case-mix points increased significantly by 31.6% during the period under review. Similarly, patient severity of illness as measured by the SAPS II score increased by 21.4%. The proportion of mechanically ventilated patients exceeded 50%. In another analysis, antibiotic spending per case-mix point was calculated. While spending was EUR 60.22 per case-mix point in 2015, this could be reduced by 42.9% to EUR 34.37 per case-mix point by 2019. Conclusion(s) Through close interprofessional collaboration between physicians, staff nurses, and pharmacists, the consumption of antibiotics and other drugs (e.g., albumin) was significantly reduced, thus improving patient care. There was also a positive economic effect - with a simultaneous increase in case-mix points, expenditure on antibiotics was significantly reduced. Responsible use of resources and high-performance medicine are not contradictory. In our view, a close interprofessional collaboration between physicians, staff nurses, and pharmacists will be of outstanding importance in the future, particularly in intensive care medicine.