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a significant reduction in patient readmissions when ED
pharmacists participated in the culture follow-up process
(7% vs 19%, P < .001). Furthermore, Dumkow and colleagues17 found a non-significant decrease in ED revisit and
hospital admission within 72 hours (16.9% vs 10.2%, P =
.079); however, this was significant in a subgroup of uninsured patients (15.3% vs 2.4%, P = .044).
We acknowledge that there were a number of limitations
associated with this study including the retrospective cohort
study design and single center model. Due to the staffing
schedule of the ASP pharmacists and the assistant ED director, culture follow-up was primarily performed during the
weekdays. Although the time to ED provider action was certainly shorter in the post-ASP implementation group, further
improvement may have been observed if weekend coverage
was available. There was also additional time that lapsed
between ASP-pharmacist review, communication with ED
providers, and ultimate decision-making that prolonged time
to appropriate therapy. To avoid this delay, some centers
have utilized a collaborative practice agreement with ED
physicians that allows ED-based pharmacists to evaluate and
modify therapy as needed. In some instances, patients
included in both the pre-ASP and post-ASP implementation
groups had results and recommendations forwarded to primary care providers and determination of final therapy selections was unobtainable. Serum creatinine data were not
available for a significant number of our patients in both
groups making this secondary outcome difficult to evaluate.
Last, the informational poster placed in the ED department
may have also helped improve empiric prescribing patterns,
although there was no significant change in the rate of inadequate therapies requiring modification after culture results
were finalized.

Conclusions
This study found that incorporation of an ASP pharmacist in
the ED culture review process is associated with a decreased
time to ED provider action on inadequate antimicrobial therapy and improved final, culture-guided therapy. In addition,
routine communication between the ASP pharmacist and the
ED provider appears to improve the selection of guidelineconcordant, empiric antimicrobial selection, and duration of
therapy. Additional research should determine if such an
intervention may reduce ED revisits or hospitalization. This
model for patient care may be of interest to centers lacking
an effective culture follow-up program.
Acknowledgments
We sincerely thank Anne Dominy, RN, BSN, for her assistance
with coordinating with ED providers and patients.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Hospital Pharmacy 55(4)
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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