Evaluation of Emergency Medicine Pharmacist Impact on Blood Culture Review Following Emergency Department Discharge
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 146
- 试验地点
- 2
- 主要终点
- Time from an actionable positive blood culture to the time of review and/or patient notification. ult.
研究概览
简要总结
Patients are commonly discharged from the Emergency Department(ED) with pending blood culture results. Blood cultures can take up to 48 hours to become positive which is why it is important to notify patients with true positive cultures as soon as possible. Delay in notification can lead to other serious complications such as sepsis, septic shock, and death.
The American College of Emergency Physicians states pharmacists serve a critical role in ensuring efficient, safe, and effective medication use in the ED and advocates for health systems to support dedicated roles for pharmacists within the ED. Pharmacists help to decrease the workload on the healthcare team, especially in the ED where there is high volume and acuity.Emergency medicine pharmacist (EMP) play a significant role in the optimization of therapy, medication safety, and reducing costs.
There is strong evidence for the positive impact EMPs have on microbiological culture review. Overall, pharmacist review of late cultures results in higher rates of appropriate antimicrobial therapy and decreased missed interventions.These prior studies focused on the review of microbiological tests, including sexually transmitted infections, urine, and wound cultures; however, there was limited data to support the role of pharmacists evaluating late blood culture results.
详细描述
A multicenter retrospective study will be conducted at Methodist Charlton Medical Center (MCMC) and Methodist Dallas Medical Center (MDMC). The study will be conducted using the EMR to collect data from patients who were discharged and had pending blood cultures from the ED between July 1, 2022 to July 1, 2023. The variables to be collected from the Electronic medical record(EMR) are listed in Appendix B. All blood culture reviews at MCMC are reviewed, acted on, and documented by pharmacists during available hours. All blood cultures reviewed at MDMC are reviewed, acted on, and documented by charge nurses and physicians. The collection of data will begin after study approval is received by the Institutional review board(IRB).
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Other
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Patients with a positive blood culture result, collected during the initial ED visit and who were discharged from the ED to the outpatient/long-term care setting prior to a critical blood Groups culture result.
排除标准
- •Patients admitted to inpatient and patients transferred from ED to another acute care facility.
研究组 & 干预措施
Charge nurse (CN's)
To determine the effect of EMPs, utilizing a CPA, on the appropriateness of antibiotic selection upon return admission for bacteremia, reasons for patient return to hospital (i.e., return due to call - expectant, worsening of symptoms - non-expectant, other) compared to the standard CN-physician facilitated process, and rates of inappropriate call backs for reassessment or admissions (i.e., contaminant call backs).
干预措施: No Intervention (Other)
Emergency medicine pharmacist (EMPs)
EMPs, utilizing a Collaborative practice agreements(CPA), will be associated with a significantly shorter time to patient review and notification of positive blood culture compared to a CN-physician review.
干预措施: No Intervention (Other)
结局指标
主要结局
Time from an actionable positive blood culture to the time of review and/or patient notification. ult.
时间窗: 18 months
Time to patient notification is defined as time until the first attempt to contact the patient regarding the actionable positive res
次要结局
未报告次要终点