Pharmacist-led transition of care in the emergency department

Pharmacist-Led Transition of Care Program in the Emergency Department (Pharm TOC-ED): A Pilot Randomized, Parallel-Group, Open-Label Trial With Embedded Process Evaluation

This pilot will test whether adding a pharmacist-led transition of care program to usual care helps adults discharged from the emergency department with multiple or high‑risk medications avoid medication problems and readmission.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 82 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Qatar University (Academic / other)
• Locations: 1 site (Al Wakrah)
• Trial ID: NCT07310199 on ClinicalTrials.gov

What this trial studies

This is a small randomized pilot comparing usual ED discharge care to usual care plus a multi‑faceted pharmacist-led transition of care program at Al‑Wakra Hospital. Eligible adults discharged home are randomized to receive either standard discharge processes or additional pharmacist services including review of discharge prescriptions, medication list reconciliation, and targeted medication education. The trial focuses on feasibility and implementation outcomes to determine whether the program can be delivered reliably in the emergency department setting. Results will inform whether a larger definitive trial should be conducted.

Who should consider this trial

Good fit: Adults (≥18) being discharged home from the Al‑Wakra Hospital emergency department who have polypharmacy (five or more chronic prescription medications), are prescribed a new high‑risk medication, or are visiting for an exacerbation of a chronic illness.

Not a fit: Patients presenting with minor acute illnesses, those lacking decision-making capacity, those not discharged home, or those already receiving overlapping pharmacist transition services are unlikely to benefit from this intervention.

Why it matters

Potential benefit: If successful, the program could reduce medication errors, adverse drug events, and emergency readmissions following ED discharge.

How similar studies have performed: Pharmacist-led medication reconciliation and discharge counseling in inpatient and outpatient settings have reduced medication discrepancies and sometimes readmissions, but pharmacist-led ED-to-home transition programs have been less extensively studied and show mixed but promising results.

Eligibility criteria

Inclusion Criteria:

* Adults (aged 18 years or more) discharged from the ED with at least one of the following:
* Polypharmacy: Five or more scheduled prescription medications for chronic illnesses (i.e., chronic maintenance medications, even if such medications were not refilled during the index ED visit)
* Discharged with a new prescription of high-risk medication, including:
* Drugs with the potential of withdrawal symptoms upon abrupt discontinuation such as antipsychotics, antiepileptics, antidepressants, and tapering glucocorticoids.
* Insulin (initiation or intensification of therapy)
* Oral hypoglycemic agents
* Visiting ED for an exacerbation of chronic illness (e.g., exacerbation of asthma, COPD, CHF, uncontrolled diabetes mellitus, hypertension urgency, uncontrolled epilepsy)

Exclusion Criteria:

* The following patients will be excluded:
* Presenting with acute minor illnesses
* Lack of decision-making capacity (including documented moderate or severe dementia, altered mental status, unstable psychiatric illness, altered consciousness level, lack of orientation to person/place/time as reported in EHR, delirium, patients seen in the ED for a psychiatric evaluation)
* Language barrier, i.e., inability to communicate in either English or Arabic as the intervention will be provided by English/Arabic speaking clinical pharmacists
* Expected length of stay in Qatar of \<30 days post discharge (including transit passengers)
* Substance use disorders (e.g., alcoholism, opioid dependency) or drug-seeking behavior, as reported in EHR
* Prisoners who are serving an active sentence
* Patients presenting for non-medical, socially driven reasons (e.g., seeking shelter, support, or resources) with no identifiable acute medical condition, and known to the ED team as recurrent visitors.
* Discharge to a location other than home (e.g., patients transferred to another hospital, long-term or skilled nursing facility)
* Study pharmacists unavailable to deliver the intervention if the patients were randomized to the intervention arm
* Pregnant women
* Patients seen for trauma or planned surgery
* Terminally ill patients
* Patients discharged from ED with watchful waiting (e.g., expected to be readmitted for an intervention such as surgical intervention if conservative management failed)
* Patients who are admitted to the hospital after enrollment (i.e., following consent but prior to ED discharge)

Where this trial is running

Al Wakrah

• Al- Wakra Hospital- Hamad Medical Corporation — Al Wakrah, Qatar (Recruiting)

Study contacts

• Study coordinator: Muhammad Abdul Hadi, PhD

Conditions Transitional Care; transition of care; Pharmacy services; Emergency Department