title: Impact of a Multidisciplinary Culture Follow-up Program of Antimicrobial Therapy in the Emergency Department.
abstract: BACKGROUND
  Antimicrobial prescribing in the emergency department is predominantly empiric, with final microbiology results either unavailable or reported after most patients are discharged home. Systematic follow-up processes are needed to ensure appropriate antimicrobial therapy at this transition of care. The objective of this study was to assess the impact of a culture follow-up (CFU) program on the frequency of emergency department (ED) revisits within 72 h and hospital admissions within 30 days compared to the historical standard of care (SOC). Additionally, infection characteristics and antimicrobial therapy were compared.
  
  
  METHODS
  A single group, pre-test post-test quasi-experimental study was conducted comparing a retrospective SOC group to a prospective CFU group. CFU was implemented using computerized decision-support software and a multidisciplinary team of pharmacists and emergency physician staff.
  
  
  RESULTS
  Over the four-month intervention period the CFU group evaluated 197 cultures and modified antimicrobial therapy in 25.5%. The rate of combined ED revisits within 72 h and hospital admissions within 30 days was 16.9% in the SOC group and 10.2% in the CFU group (p = 0.079). When evaluating the uninsured population alone, revisits to the ED within 72 h were reduced from 15.3% in the SOC group to 2.4% in the CFU group (p = 0.044).
  
  
  CONCLUSIONS
  Implementation of a multidisciplinary CFU program was associated with a reduction in ED revisits within 72 h and hospital admissions within 30 days. One-fourth of patients required post-discharge intervention, representing a large need for antimicrobial stewardship expansion to ED practice models.
authors.affiliation: Mercy Health St. Mary's, Grand Rapids, MI, USA.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Dumkow
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Kenney
authors.forename: Nancy C
authors.initials: NC
authors.lastname: MacDonald
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Carreno
authors.forename: Manu K
authors.initials: MK
authors.lastname: Malhotra
authors.forename: Susan L
authors.initials: SL
authors.lastname: Davis