Evaluation of Antimicrobial Stewardship in an Academic Medical Center Emergency Department (ED)
Methods: This quality assurance project included all patients with positive culture results after being discharged home from the ED. The culture review process included screening the daily laboratory patient report for positive results, collecting pertinent data, and determining if empiric therapy at discharge from ED was appropriate based on current evidence-based practice guidelines. If lab result was positive for a sexually transmitted disease (STD) or empiric therapy inappropriate, an attempt was made to contact the patient and/or PCP by phone. If available, notified of test result(s) and called in new prescription when indicated. If unavailable, letter was sent to the patient’s stated home address. The control group (6 weeks) assessed the current practice of ED Physician Assistant (PA) culture follow-up and the intervention group (15 weeks) assessed the transition to ASP-pharmacist management. Data was collected retrospectively for the control phase and prospectively during the intervention period. This project was IRB approved and data was analyzed using SPSS-PC (ver. 21).
Results: During the intervention phase, attempted patient and/or PCP follow-up occurred in 72/73 (98.7%) cases versus 10/22 (45.5%) in the control group (p < 0.001). No differences in percentage of inappropriate empiric prescribing were seen (44.9% vs 41.2%, p > 0.05). Comparing control versus intervention group, STD and urinary tract infection (UTI) accounted for the majority of mistreated infections. Of the reasons for inappropriate empiric therapy, no treatment prescribed and drug-bug mismatch were the most common. In addition, a sub group analysis of STD treatment in ED patients revealed deficiencies in provider prescribing practices and as a result education was provided.
Conclusion: Implementation of an ASP in the ED can improve timeliness of culture review and provide more consistent patient follow-up while reducing the non-clinical workload of ED providers.
R. Vivekanandan, None
K. Baack, None
J. Horne, None
T. Burns, None