Evaluation of a pharmacist-led antimicrobial stewardship service in a pediatric emergency department

Background To improve antimicrobial use, incorporation of a pharmacist in antimicrobial stewardship initiatives in the emergency department has been recommended. Recognizing the potential value, a pharmacist-led antimicrobial stewardship (AMS) service which included review and follow up of microbiology results for patients discharged from the pediatric emergency department (PED) with suspected infections was implemented at our local institution. Objective The objective of this study was to evaluate the impact of pharmacists delivering this service compared to usual care. Setting Pediatric emergency department at the IWK Health Centre in Halifax, Canada. Method This study was completed as a retrospective chart review of pediatric patients discharged from the PED 6 months before and after implementation of the pharmacist-led AMS service. Data was extracted from electronic medical records. Data were reported descriptively and compared using a two-sided chi-square test and ordinal logistic regression. Main outcome measures The primary outcome measure was rate of return visits to the PED within 96 h of initial presentation. Results This study included 1070 patient encounters pre-implementation and 1040 patient encounters post-implementation. The rate of return visits to the PED within 96 h was 12.0% (129/1070) pre-implementation vs. 10.0% (100/1049) post-implementation (p = 0.07). The rate of return visits or hospitalization at 30 days was 22.1% (237/1070) pre-implementation compared to 19.9% (207/1040) in the post-implementation phase (p = 0.21). Inappropriate antimicrobial therapy was identified more often in the pre-implementation phase (7.0%, 68/975) vs. the post-implementation phase (5.0%, 46/952), p = 0.047. Time to notification within the first day after discharge occurred more frequently in the post-implementation phase (53.3%, 80/150) as compared to the pre-implementation phase (40.3%, 52/129, p = 0.0298). Conclusion Although this pharmacist-led AMS service did not significantly affect the rate of return visits or hospitalization, it may have led to more judicious use of antimicrobial agents and faster time to notification.