Implementation of an ambulatory care-based pharmacist in the emergency department.

The burden of overcrowding affects emergency departments across the US. Many patients struggle with access to primary care physicians and are often lost to follow-up, leading to poor management of chronic disease states and patients utilizing emergency medicine services to meet their needs. As such, there is potential to evolve emergency medicine pharmacy practice to have a greater focus on lower-acuity presentations. However, literature describing the role of transitions-of-care or ambulatory care pharmacists within the emergency department setting is limited. To explore this opportunity, an innovative practice improvement project was led by two pharmacy residents utilizing an implementation science framework. While the higher risk of poor patient outcomes at transitions of care and the critical role of ambulatory care pharmacists have previously been reported,1,2 there is a limited body of evidence demonstrating the efficacy of a transitions-of-care pharmacist specifically localized to the emergency department.3 One project by Hohner and colleagues4 utilized ambulatory care and emergency medicine pharmacists to focus on patients in the emergency department who had asthma, chronic obstructive pulmonary disease, or heart failure. Once such patients were identified, they were provided education by the clinical pharmacist who screened them and enrolled in existing ambulatory services if eligible. In another article, Foster and colleagues 5 ,6 created an ambulatory care pharmacist service to address a care gap in the management of respiratory chronic disease states utilizing the EPIS framework.