RT Journal Article SR Electronic T1 Inpatient pharmacists using a readmission risk model in supporting discharge medication reconciliation to reduce unplanned hospital readmissions: a quality improvement intervention JF BMJ Open Quality JO BMJ Open Qual FD British Medical Journal Publishing Group SP e001560 DO 10.1136/bmjoq-2021-001560 VO 11 IS 1 A1 David Gallagher A1 Maegan Greenland A1 Desirae Lindquist A1 Lisa Sadolf A1 Casey Scully A1 Kristian Knutsen A1 Congwen Zhao A1 Benjamin A Goldstein A1 Lindsey Burgess YR 2022 UL http://bmjopenquality.bmj.com/content/11/1/e001560.abstract AB Introduction Reducing unplanned hospital readmissions is an important priority for all hospitals and health systems. Hospital discharge can be complicated by discrepancies in the medication reconciliation and/or prescribing processes. Clinical pharmacist involvement in the medication reconciliation process at discharge can help prevent these discrepancies and possibly reduce unplanned hospital readmissions.Methods We report the results of our quality improvement intervention at Duke University Hospital, in which pharmacists were involved in the discharge medication reconciliation process on select high-risk general medicine patients over 2 years (2018–2020). Pharmacists performed traditional discharge medication reconciliation which included a review of medications for clinical appropriateness and affordability. A total of 1569 patients were identified as high risk for hospital readmission using the Epic readmission risk model and had a clinical pharmacist review the discharge medication reconciliation.Results This intervention was associated with a significantly lower 7-day readmission rate in patients who scored high risk for readmission and received pharmacist support in discharge medication reconciliation versus those patients who did not receive pharmacist support (5.8% vs 7.6%). There was no effect on readmission rates of 14 or 30 days. The clinical pharmacists had at least one intervention on 67% of patients reviewed and averaged 1.75 interventions per patient.Conclusion This quality improvement study showed that having clinical pharmacists intervene in the discharge medication reconciliation process in patients identified as high risk for readmission is associated with lower unplanned readmission rates at 7 days. The interventions by pharmacists were significant and well received by ordering providers. This study highlights the important role of a clinical pharmacist in the discharge medication reconciliation process.Data are available upon request. Deidentified Data are available upon reasonable request and after approval of request by Duke Health research leadership.