“An empiric antimicrobial guide specific for severe sepsis was associated with a reduced length of stay, a significantly earlier time to first dose antibiotic, and significantly lower total and variable hospital costs,” reported Hutchison et al.⁺¹ Information was abstracted from charts of 119 patients treated at a large medical center. The control group consisted of 67 patients treated before implementation of the medication guide, and the intervention group included 52 patients treated after implementation. The guide provided recommendations of first and second antibiotic choice based on the origin (e.g., health care iatrogenesis, community-acquired or a patient with neutropenia) and the location of the severe sepsis (e.g., lung, skin, gastrointestinal). Postimplementation, the time to first antibiotic administration (9.8 ± 8.8 vs. 14.7 ± 11.5 hours) and the overall length of stay (1.77 ± 1.13 vs. 14.90 ± 45.07 days) were significantly shorter. Significant cost savings were realized in the total (30%) and variable costs ($2,831) of the patient stay.

Implications. The two most important factors in successful sepsis treatment are time to treatment and antibiotic choice. Evidence-based recommendations contained on a single page were cost effective and improved care by getting the correct antibiotic to the patient more quickly.

Pape et al.⁺² concluded that “remotely located physician-pharmacist team-based care resulted in significantly improved LDL-C levels and goal attainment.” A total of 6,963 patients with diabetes and dyslipidemia were cared for by 68 physicians at nine clinics. A pharmacist based at a remote location developed individualized, evidence-based treatment and follow-up laboratory monitoring recommendations. Recommendations were electronically sent for physician review. With physician consent, pharmacists called patients 38% of the time. Of note, physicians chose to call patients themselves 62% of the time. Overall, intervention group patients (n = 2,047) were more likely to achieve low-density lipoprotein (LDL) cholesterol goals (78% vs. 50%) and lower mean LDL cholesterol levels (83 mg/dL [95% CI 82–85] vs. 95 [91–97]), and 15% more received a lipid-lowering medication compared with the control group (n = 4,916). After adjusting for age, BMI, statin prescription, and baseline LDL cholesterol goal attainment, intervention group patients were nearly three times more likely to achieve LDL cholesterol goals (adjusted odds ratio 2.8 [95% CI 2.2–3.7]).

Tundia et al.⁺³ concluded that “by identifying specific adverse drug events (ADEs) that occur most often and/or have the highest burden, physicians and hospital administrators can better target strategies for reducing pediatric medication‐related harm.” Of 7,558,812 hospital discharges in 2006, ADEs were associated with 0.9% of the total number of discharges. Among these ADE-related visits, 79.4% involved an adverse event, 19.6% involved accidental poisonings (APs), and 10.5% involved another ADE (e.g., neuropathy, dermatitis). Compared with the average length of stay (LOS; 3.7 days), visits involving ADEs had a higher mean LOS (5.4 days) and cost ($15,183) compared with other hospital visits. Visits involving APs were similar to other hospital visits regarding mean LOS and cost.

Implications. A nationwide estimate of the burden and sources of pediatric ADEs will help interdisciplinary teams to systematically target preventable ADEs. Expert panels should use this information to develop safety guidelines.