Evaluating the impact of emergency department clinical pharmacist integration within a discharge urine culture follow-up program

Abstract

Introduction: Patients are often discharged from the emergency department (ED) prior to final culture results, leading to the development of post-ED discharge urine culture review programs (UCRPs) to ensure appropriate management. The purpose of this study was to evaluate the impact ED pharmacists have on antibiotic management and determine areas for improved antimicrobial stewardship efforts. Methods: This was a single-system, retrospective, quasi-experimental study of patients who visited the ED for evaluation of a urinary tract infection comparing no pharmacist involvement in a culture review to a process when ED pharmacists were involved. Patients included those discharged from the ED requiring review under a UCRP. Incarcerated patients and those admitted to an inpatient service from the ED were excluded. The primary outcome was the receipt of guideline-appropriate management. Secondary outcomes included unplanned admission or ED revisit within 14 and 30 days related to the initial ED visit, all-cause hospital admission or ED revisit within 14 and 30 days, and acceptance rate of pharmacist recommendations. Results: A total of 142 patients were included (before pharmacist integration = 70, after pharmacist integration = 72). Receipt of guideline-appropriate management occurred at 33% without pharmacist integration and 85% in the arm with pharmacist integration, p < 0.001. Pharmacist recommendations were accepted in 97% of cases. No difference was noted between ED revisit within 14 and 30 days with a chief complaint directly related to the initial ED visit, 14 and 30 day admission related to the initial encounter, and all-cause hospital admission or ED revisit within 14 and 30 days. In patients with asymptomatic bacteriuria, there was a higher receipt of inappropriate management 67% (20/30) in the time before pharmacist integration versus 19% (9/48) after pharmacist integration (p < 0.001). Conclusion: There was a significantly higher number of patients with appropriate antimicrobial management after pharmacist involvement in UCRP review.