Faculty Collaboration Database

Involvement of pharmacist-reviewed urine cultures and sexually transmitted infections in the emergency department reduces time to antimicrobial optimization. Am J Health Syst Pharm 2020 May 19;77(Supplement_2):S54-S58

Date

05/20/2020

Pubmed ID

32426834

DOI

10.1093/ajhp/zxaa064

Scopus ID

2-s2.0-85084786424 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

PURPOSE: To streamline workflow of the culture review process in the emergency department (ED), a transition from a nurse-driven to a pharmacist-initiated process was implemented.

METHODS: This was a single-center retrospective study conducted at an adult urban level 1 trauma academic medical center. The pharmacist-initiated culture review process was compared to the previous nurse-initiated process. The primary objective was time from final culture result to patient contact by an advanced practice provider. Secondary objectives included incidence of treatment failure and hospital admission within 30 days of ED visit.

RESULTS: A total of 283 patients met inclusion criteria: 144 patients in the pre-intervention group and 139 patients in the postintervention group. Patients were contacted a median time of 15.7 hours (95% confidence interval [CI], 9.88-18.83) earlier for definitive urinary tract infection antibiotic therapy and 46.7 hours (95% CI, 33.34-61.62) earlier for definitive sexually transmitted infection therapy in the pharmacist-initiated workflow compared to the nurse-initiated workflow (P < 0.001). Treatment failure occurred in 0.01% of patients in the postintervention group and 6.3% in the pre-intervention group (P = 0.01). Hospital admission within 30 days of the ED visit occurred in 0% of patients in the postintervention group and 4.2% in the pre-intervention group (P = 0.03).

CONCLUSION: Pharmacist-initiated culture review in the ED at an academic medical center reduced time from final culture to patient contact for optimal antibiotic therapy and decreased hospital admission and treatment failure rates. A change in the culture review workflow involving pharmacists appears to have a positive impact on clinical outcomes.

Author List

Olson A, Feih J, Feldman R, Dang C, Stanton M

Authors

Ryan J. Feldman PharmD Adjunct Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin
Matthew Stanton PharmD Adjunct Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Adolescent
Adult
Anti-Bacterial Agents
Emergency Service, Hospital
Female
Hospitalization
Humans
Male
Middle Aged
Pharmacists
Pharmacy Service, Hospital
Professional Role
Retrospective Studies
Sexually Transmitted Diseases
Time Factors
Treatment Failure
Urinary Tract Infections
Young Adult