Evaluation of a Pharmacist Culture Review Process in an Emergency Department

Purpose: To evaluate a pharmacist directed culture review process in the Emergency Department (ED) at a large community teaching hospital in Central Illinois.  The process focuses on patients who are discharged to home prior to final culture information being available.  These cultures are followed to assess whether empiric therapy was appropriate based on the site of infection and organism isolated, the need for additional care or a change in therapy.

Methods: A retrospective chart review was performed on cultures obtained in the ED on all non-admitted patients from August 1^st-January 31^st. Pharmacist interventions are stored in the electronic database.  An Excel spreadsheet of intervention data was reviewed and analyzed.

Results: Total number of cultures reviewed by pharmacist was 5,323 of which 1,625 were positive.  Cultures were treated appropriately by physician 76.2% of the time (n=1,245).  Cultures most commonly requiring pharmacist intervention included urine at 36% and sexually transmitted infections (STI) at 32%.  The majority of urine cultures (77/139) required pharmacist intervention due to drug-microorganism mismatch.  E. coli resulted as most common urine microorganism requiring pharmacist intervention (33/77).  Sulfamethoxazole/trimethoprim and levofloxacin were most commonly prescribed at 13/33 (39.4%) and 12/33 (36.4%), respectively, which required subsequent intervention due to non-susceptible E. coli.

Conclusion: Pharmacist intervention was required on 23.8% of positive cultures (n=390). Cost avoidance as a result of return ED visits prevented in patients with no PCP calculated at $64,274.31.  Urine cultures required the most pharmacist interventions due to drug-microorganism mismatches of E. coli against sulfamethoxazole/trimethoprim and levofloxacin.  This suggests that current prescribing practices for empiric urinary tract infections in the ED may not be adequate for local sensitivities.