Drug-related illness in emergency department patients

Drug-related illnesses (DRIs) associated with visits to a hospital emergency department (ED) were identified and classified, and the cost of these DRIs was analyzed. A pharmacist reviewed all available ED log forms on file at a 560-bed teaching hospital for October 1994. The following information was collected from these forms and, for patients with a documented or suspected DRI, the medical record: medication and allergy history, drug involved in and cause of the DRI, diagnosis, patient compliance, serum drug concentrations, and length of hospital stay. A patient was identified as having had a DRI if he or she was taking a drug before the ED visit and if a DRI was documented on the ED log form or suspected by the pharmacist. DRIs were classified as having been caused by inappropriate prescribing, patient noncompliance, an adverse drug reaction (ADR), or a drug interaction. DRIs were considered preventable if they could have been avoided through appropriate prescribing, outpatient monitoring, or compliance. A cost analysis was performed. Of 1260 ED log forms reviewed, 565 (45%) described patients receiving drugs before the ED visit. A total of 50 DRIs were discernible in 49 log forms (3.9% of all 1260 forms, and 8.6% of the 565 forms describing patients taking medications before the visit). Noncompliance, inappropriate prescribing, and ADRs accounted for 58%, 32%, and 10% of the DRIs, respectively. The drugs most frequently involved were albuterol, insulin, and warfarin. Thirty-three (66%) of the DRIs were considered to have been preventable; these DRIs accounted for an estimated $391,342 in annual ED and hospital costs. Many DRIs seen in the ED patients were preventable, and these preventable illnesses contributed substantially to ED and hospital costs.