Medication errors are a leading contributor to adverse events after hospital discharge, and prior studies have demonstrated a high incidence of inadvertent medication discrepancies at the time of discharge. Pharmacist involvement in inpatient care is a proven strategy to improve safety, and a pharmacist-led medication reconciliation and education process successfully reduced medication errors and hospital readmissions in a prior study. In this trial, while the involvement of a pharmacist in medication teaching, medication reconciliation, communication of medication changes to outpatient physicians, and post-discharge telephone follow-up with patients did appear to reduce medication discrepancies, it had no impact on rates of readmissions and emergency department visits. This finding may indicate that more comprehensive discharge interventions may be necessary in order to reduce the risk of readmission.