Pharmacist addition to the post-ED visit review of discharge antimicrobial regimens

Miller, Kimberly A.; McGraw, Molly; Tomsey, Alyssa; Hegde, Gajanan G.; Shang, Jennifer; O'Neill, John; Venkat, Arvind

doi:10.1016/j.ajem.2014.07.033

Cited by 27 publications

(14 citation statements)

References 12 publications

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“…Pharmacist involvement was explicitly described in 13 studies. 26,27,32,35,36,49,51-57 The remainder of the studies primarily involved ED physicians and nurses or provided insufficient details on which ED providers were involved in the intervention. The most common intervention that included pharmacist participation was culture review and follow-up for patients discharged from the ED 27,51,53-57 and education.…”

Section: Resultsmentioning

confidence: 99%

“…26,27,32,35,36,49,51-57 The remainder of the studies primarily involved ED physicians and nurses or provided insufficient details on which ED providers were involved in the intervention. The most common intervention that included pharmacist participation was culture review and follow-up for patients discharged from the ED 27,51,53-57 and education. 26,32,35,36 Of the 8 studies that evaluated the impact of improving the culture and review process for patients discharged from the ED, 18,27,51,53,54,56,57 7 compared pharmacist-managed or facilitated culture review and follow-up with other health care providers.…”

Section: Resultsmentioning

confidence: 99%

“…The most common intervention that included pharmacist participation was culture review and follow-up for patients discharged from the ED 27,51,53-57 and education. 26,32,35,36 Of the 8 studies that evaluated the impact of improving the culture and review process for patients discharged from the ED, 18,27,51,53,54,56,57 7 compared pharmacist-managed or facilitated culture review and follow-up with other health care providers. 27,51,53-57 Randolph et al 51 found a significant decrease in readmission rates within 96 hours with culture review and follow-up by a pharmacist in consultation with the ED physician compared with a physician alone.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department

et al. 2017

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department

et al. 2017

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“…[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.…”

Section: Introductionmentioning

confidence: 99%

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

2019

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Background: Antimicrobial stewardship programs (ASP) have been widely implemented in hospitals to improve antimicrobial use and prevent resistance. However, the role of ASP in the emergency department (ED) setting is not well defined. Objective: The objective of this study is to evaluate the impact of an ASP pharmacist culture review service in an ED. Methods: This was a retrospective, quasi-experimental study of all patients discharged from the ED with a positive culture. Patients discharged from the ED from February 1, 2015 to October 31, 2015 were managed by ED providers (pre-ASP), and those discharged from February 1, 2016 to October 31, 2016 were managed by a pharmacist-driven ASP (post-ASP implementation). The primary outcome was median time to change of antibiotic(s) in patients with inadequate antimicrobial therapy based on culture results. Secondary outcomes included time to culture evaluation, appropriateness of antimicrobials, and 30-day readmissions. Results: A total of 790 patients were included in the analysis (398 in pre-ASP group vs 392 in post-ASP implementation group). Median time to modification of inadequate antibiotic therapy decreased from 6.79 days in the pre-ASP group to 1.99 days in the post-ASP implementation group ( P < .0001). Median time to culture review decreased in the post-ASP implementation group from 9.83 to 0.32 days ( P < .0001). Appropriateness of culture-guided therapy increased in the post-ASP implementation group from 85.7 to 91.8% ( P = .047). The rate of combined ED revisits and hospital readmissions was similar between groups ( P = .367). Conclusion: ASP pharmacist evaluation of positive cultures in the ED was associated with a significant decrease in the time to appropriate therapy in patients discharged with inadequate therapy and higher rates of appropriate antimicrobial therapy.

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“…physician notification, 3 modification of antibiotic regimen in some cases, [4][5][6] and decreased ED and/or hospital readmissions. 7,8 Although there are studies that have been done in pediatric urgent care centers linked to a pediatric hospital, 9,10 to our knowledge there are no pediatric studies that have reported similar findings in pediatric patients discharged from a pediatric ED.…”

mentioning

confidence: 99%

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

Tweedle¹,

Mercado²,

Truesdale

et al. 2020

JACEP Open

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Pharmacist addition to the post-ED visit review of discharge antimicrobial regimens

Cited by 27 publications

References 12 publications

A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department

A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department

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

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

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