- Emergency medicine pharmacist presence in emergency department (ED) is linked to a higher rate of appropriate antibiotic use for patients with community-acquired pneumonia (CAP) or intra-abdominal infection (CA-IAI).
- American College of Emergency Physicians and American College of Medical Toxicology affirm the value of emergency medicine pharmacists.
Why this matters
- 16% of ED patients receive antibiotic prescriptions.
- Antimicrobial use is frequently inappropriate.
- Retrospective cohort study, adults with CAP or CA-IAI seen in community teaching ED (n=320).
- Records from 2 1-year periods: soon after a hospital-implemented antimicrobial stewardship program (ASP), and 2 years later.
- In 185 cases, emergency medicine pharmacist was present during shift.
- Outcome: rate of guideline-concordant antimicrobial prescribing.
- Funding: None.
- Guideline-concordant prescription rates, with vs without pharmacist: 78% vs 61% (P=.001).
- CAP (n=160): 95% vs 79% (P=.005);
- CA-IAI (n=160): 62% vs 44% (P=.025).
- Concordance rose in later vs early ASP cohorts (82.5% vs 60%; P<.001>
- With vs without guideline-concordant prescription in ED, rate of same prescription being continued upon admission (82.5% vs 18.8%; P<.001>
- With vs without pharmacist: no difference in hospital-onset Clostridium difficile infection, in-hospital mortality, length of stay.
- Risk for selection bias.
- Documentation of pharmacist involvement in antibiotic decision-making was not required.