Background A common reason for emergency admissions is medication related adverse events.

Purpose To evaluate whether the addition of a specialist in clinical pharmacy in the Emergency Department (ED) would be beneficial for the quality of care, and identify which patients should be focused on.

Materials and methods The pharmacist reviewed the patient files in the ED. A tentative diagnosis and a plan for treatment should be established. In case of a pharmacist suggesting any kind of medical intervention, a notice in the file was made describing the problem and a suggestion for a solution. After the study period 2 specialists in internal medicine, clinical pharmacology and geriatric disease reviewed a sample of the patient's files. An evaluation of the importance of the pharmacist notice was put into 4 categories: 1. Minimal (4%) 2. Moderate, risk of increased examination or treatment intensity (49%) 3. Significant, risk of significant increased examination or treatment intensity (44%) 4. Disastrous, risk of death or permanent damage (3%) Statistics included univariate and multivariate analysis of all variables registered. A p-value of <0,05 was chosen as significant.

Results During the study period (130 working days) a total of 1696 patient files were reviewed. The number of pharmacists' notices amounted to 420. Among these a random sample of 324 notices were studied. In the multivariate analysis only age above 70 years remained of significant importance for identifying patients with a serious intervention. Furthermore there was a higher risk of serious interventions for patients with one drug as opposed to 2-9 drugs. Conclusions The authors found that there is a high incidence of serious pharmaceutical intervention in the ED not discovered by the physicians. These are especially prevalent among the older patients, regardless of the number of prescriptions. It is remarkable that risk situations occur even with one drug prescription.