Program Schedule

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Evaluation of the Impact of a Clinical Decision Support Tool and Pharmacist Telephone Consultation Within 48 hours of Discharge on Unscheduled Emergency Department Encounters for Skin and Soft Tissue Infections

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background:

The National Transitions of Care Coalition (NTOCC) describes medication-related problems as a major source of concern for emergency departments (ED), especially during the discharge process. The primary objective of this project was to evaluate the impact of a clinical decision support (CDS) tool for skin and soft tissue infections (SSTI) and pharmacist telephone consultation within 48 hours of discharge on the proportion of patients that have an unscheduled ED encounter for SSTI within 7 days of discharge.

Methods:

To enhance antibiotic prescription adherence to health-system guidelines, a CDS tool was implemented into the ED electronic medical charting system. A series of pre-created SSTI discharge prescriptions for oral antibiotics were implemented to guide appropriate dosing based on patient-specific clinical data. Patients were contacted for pharmacist consultation within 48 hours of ED discharge.

To assess the impact of the interventions, the pharmacy department conducted a retrospective and concurrent evaluation of patients presenting to the ED with an ICD-9 diagnosis code of SSTI between 5/1/2013 6/31/2013 (retrospective) and 1/1/2014 3/31/2014 (concurrent following implementation of CDS and phone consultation).

Results:

A total of 130 patients were included in the retrospective arm and 108 included in the prospective arm.

 

Retrospective

Prospective (Not Reached)

Prospective (Reached)

p-value

ED re-encounters at 7 days

11.5 %

(15/130)

15.8%

(9/61)

4.3%

(2/47)

 

Hospital admissions at 7 days

1.5%

(2/130)

1.6% (1/61)

0% (0/47)

 

Prescription adherence to health-system antimicrobial guidelines

26.2% (34/130)

55.7% (68/122)

p<0.0001

Conclusion:

Results for the primary outcome suggest that a pharmacist telephone consultation within 48 hours of ED discharge may result in a decrease in re-encounters at 7 days. Results further demonstrate that implementation of the CDS tool to guide antibiotc selection in the ED significantly improved adherence to health-system antimicrobial guidelines.

Further investigation is required to determine the impact of a CDS on ED re-encounters, hospital admissions, and patient outcomes.

Figure 1:

 

Christo Cimino, PharmD1, Nishaminy Kasbekar, PharmD, FASHP1, Judith O'donnell, MD2, Christian Boedec3, Christopher Edwards, MD3 and Amanda Binkley, PharmD, AAHVIP1, (1)Pharmacy, Penn Presbyterian Medical Center, Philadelphia, PA, (2)Infectious Diseases, University of Pennsylvania Health System, Philadelphia, PA, (3)Emergency Department, University of Pennsylvania Health System, Philadelphia, PA

Disclosures:

C. Cimino, None

N. Kasbekar, None

J. O'donnell, None

C. Boedec, None

C. Edwards, None

A. Binkley, None

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