2025 Southeastern Residency Conference

Title: Evaluation of Clinical Pharmacy Involvement in Emergency Department Culture Follow-up Services 


Authors: Leah J. Clark, Nicholas (Cade) Pritchett, Jason E. Dover, and Elizabeth W. Covington
Objective: At the conclusion of my presentation, the participant will be able to describe potential benefits of clinical pharmacist integration into culture follow-up services.
Self-Assessment Question: 
Which of the following best describes the impact of clinical pharmacist integration based on the results of this study?
A. Reduced 30-day re-hospitalization/ED re-visit
B. Reduced patient pick-up of follow-up prescription
C. Reduced fluoroquinolone prescribing for urine cultures
D. Reduced time to patient contact
 
Answer: D
Background: Recently, emergency departments (ED) have invested in programs such as microbiologic culture follow-up to ensure test results received post-discharge are followed up appropriately and in a timely manner. To preserve quality of care and improve workflow, pharmacists have been integrated into these services. Current literature mainly includes pre-post studies assessing culture follow-up services before and after pharmacist involvement.  The purpose of this study is to directly evaluate ED culture follow-up services between a main emergency department with pharmacy oversight compared to two externally located emergency departments without pharmacy oversight.
Methods: This single-center retrospective, observational study evaluated patients who had microbiology data resulting after discharge from the ED between August 2023- February 2024 at three EDs affiliated with East Alabama Health. Patients were excluded if they needed additional care, such as transfer or admission, or expired during their ED visit. A control group consisting of the external EDs (150 patients), where advanced practice providers independently manage culture follow-up, was compared to the main ED (150 patients), where clinical pharmacists are involved.  The primary outcome was time from culture result to first attempted patient contact. Secondary outcomes included callback intervention errors, time to initial culture review, and readmission rates. Categorical data were analyzed via chi-square or Fisher’s exact test. Continuous data were analyzed via student’s t-test or Mann-Whitney U test based upon distribution. Statistical significance was defined by a 2-tailed p-value < 0.05.
Results: Baseline characteristics were balanced between the groups with except for age and reason for ED visit. The median time from culture result to first attempted patient contact was 5.2 hours [1.7-27.3] in the main ED compared to 25.0 hours [5.8-57.6] for the external EDs (P < 0.001). The main ED also demonstrated fewer callback intervention errors, 8.7% versus 22.7% (P = 0.001), and shorter time to initial culture review, 3.1 hours [1.1-5.3] versus 8.8 hours [3.8-23.9] (P < 0.001). There was no difference in readmission or ED revisits.
Conclusion: There was a significant difference in time from culture result to first attempted patient contact with the integration of pharmacy services. Further research is needed to evaluate the impact pharmacy integration has on clinically relevant outcomes such as readmission.