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Antimicrobial Therapy for Pneumonia in the Emergency Department: The Impact of Clinical Pharmacists on Appropriateness
Journal article   Open access   Peer reviewed

Antimicrobial Therapy for Pneumonia in the Emergency Department: The Impact of Clinical Pharmacists on Appropriateness

Brett A Faine, Nicholas Mohr, Jenna Dietrich, Laura Meadow, Kari Harland and Elizabeth Chrischilles
The western journal of emergency medicine, Vol.18(5), pp.856-863
08/2017
DOI: 10.5811/westjem.2017.5.33901
PMCID: PMC5576621
PMID: 28874937
url
https://doi.org/10.5811/westjem.2017.5.33901View
Published (Version of record) Open Access

Abstract

Pneumonia impacts over four million people annually and is the leading cause of infectious disease-related hospitalization and mortality in the United States. Appropriate empiric antimicrobial therapy decreases hospital length of stay and improves mortality. The objective of our study was to test the hypothesis that the presence of an emergency medicine (EM) clinical pharmacist improves the timing and appropriateness of empiric antimicrobial therapy for community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP). This was a retrospective observational cohort study of all emergency department (ED) patients presenting to a Midwest 60,000-visit academic ED from July 1, 2008, to March 1, 2016, who presented to the ED with pneumonia and received antimicrobial therapy. The treatment group consisted of patients who presented during the hours an EM pharmacist was present in the ED (Monday-Friday, 0900-1800). The control group included patients presenting during the hours when an EM clinical pharmacist was not physically present in the ED (Monday-Friday, 1800-0900, Saturday/Sunday 0000-2400 day). We defined appropriate empiric antimicrobial therapy using the Infectious Diseases Society of America consensus guidelines on the management of CAP, and management of HCAP. A total of 406 patients were included in the final analysis (103 treatment patients and 303 control patients). During the hours the EM pharmacist was present, patients were significantly more likely to receive appropriate empiric antimicrobial therapy (58.3% vs. 38.3%; p<0.001). Regardless of pneumonia type, patients seen while an EM pharmacist was present were significantly more likely to receive appropriate antimicrobial therapy (CAP, 77.7% vs. 52.9% p=0.008, HCAP, 47.7% vs. 28.8%, p=0.005). There were no significant differences in clinical outcomes. The presence of an EM clinical pharmacist significantly increases the likelihood of appropriate empiric antimicrobial therapy for patients presenting to the ED with pneumonia.
 United States Clinical Competence Humans Middle Aged Anti-Infective Agents - therapeutic use Cross Infection - drug therapy Emergency Medicine - standards Anti-Bacterial Agents Pneumonia - drug therapy Community-Acquired Infections - drug therapy Adult Emergency Service, Hospital - manpower Aged Retrospective Studies Pharmacists Emergency Service, Hospital - standards

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