Evaluation of Pharmacist Impact on Culture Review Process for Patients Discharged from the Emergency Department

Abstract

Background Accurate and timely review of microbiological test results is a core component of antimicrobial stewardship. There is documented success of these programs in the inpatient setting; however, emergency department (ED) patients are typically not included in these initiatives. Objectives To assess the impact of an emergency medicine pharmacist (EMP)–facilitated review process of positive microbiological test results from patients discharged from the ED as measured by time to positive result review and number of indicated interventions completed. Methods This was a retrospective study that compared EMP-facilitated to ED charge nurse (CN)–facilitated physician review of randomly selected positive microbiological test results. Groups were compared concurrently within the time frame of July 1, 2012 through December 31, 2012. Results One hundred seventy-eight positive microbiological test results were included (EMP, n = 91; CN, n = 87). The median (IQR) time to initial review was 3 (1.0–6.3) hours for the EMP and 2 (0.3–5.5) hours for the CN group ( p = .35). Four percent (1/25) of indicated interventions were not completed in the EMP group versus 47% (14/30) in the CN group ( p = .0004). Conclusion An EMP was significantly less likely to miss an intervention when indicated with no difference in time to review of positive microbiological results. These findings support the role of the EMP in antimicrobial stewardship in the ED.

Evaluation of Antibiotic Utilization in an Emergency Department After Implementation of an Antimicrobial Stewardship Pharmacist Culture Review Service

“…Baker and colleagues also noted that time to follow-up and action were more rapid (2 vs 3 days, P = .0001) when conducted by a dedicated ED pharmacist. 15 Similarly, Santiago and colleagues 20 identified that a pharmacist-driven culture review process missed fewer patients who needed follow-up as compared to a nurse-driven process (4% vs 47%, P = .0004). While our study was not powered to detect a change in ED return visits or hospital admissions after discharge from the ED, others have seen reductions in these outcomes.…”

“…[12][13][14] To date, the available data on culture review services in the ED are generally limited to institutions with dedicated ED clinical pharmacists. [15][16][17][18][19][20][21][22][23] Although some programs have reported reduced hospital admissions and ED revisits with pharmacist involvement in antibiotic selection, they have not routinely seen improvement in empiric therapy selection. [15][16][17] Furthermore, all of these studies were performed in large academic or tertiary medical centers.…”

Decreasing review and notification times of genital and urine cultures in a pediatric emergency department: An observational before and after study

“…This is consistent with previous studies. 3,6,12,13,14 We hypothe- the ED may decrease ED revisits within 72 hours and hospital readmission rates within 30 days, 3,6,12,13 decreasing time to review 3,6,12 and subsequent patient/family or primary care physician notification. 6,13 Although our study found a decrease in the times to notification of patients and families of positive culture results and a decrease in the times to review of positive results, we did not evaluate the effect of this on ED return visits.…”

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

“…Santiago et al sought to compare culture follow-up by emergency medicine pharmacist review versus nurse in charge review [24]. The median time to initial review was 3 hours (1.0-6.3 hours) in the pharmacist group versus 2 hours (0.3-5.5) in the nurse group (p = 0.35).…”