Evaluation of Emergency Medicine Pharmacist Impact on Blood Culture Review Following Emergency Department Discharge

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.

Study Overview

• Status: Recruiting
• Conditions: Bacteremia
• Intervention / Treatment: Other: No Intervention

Detailed Description

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).

• Study Type: Observational
• Enrollment (Estimated): 126

Contacts and Locations

• Study Contact: Name: Crystee Cooper, DHEd; Phone Number: 214-947-1280; Email: ClinicalResearch@mhd.com

Study Locations

• United States
  • Texas
    • Dallas, Texas, United States, 75203
      • Recruiting
      • Clinical Research Institute Methodist Health System
      • Contact: Crystee Cooper, DHEd; Phone Number: 214-941-1285; Email: CrysteeCooper@mhd.com
      • Contact: Email: clinicalresearch@mhd.com
      • Principal Investigator: Kevin Burnham, PharmD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

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 Groupsculture result.

Description

Inclusion Criteria:

• 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.

Exclusion Criteria:

• Patients admitted to inpatient and patients transferred from ED to another acute care facility.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
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.	Other: No Intervention; No Intervention
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).	Other: No Intervention; No Intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time from an actionable positive blood culture to the time of review and/or patient notification. ult.	Time to patient notification is defined as time until the first attempt to contact the patient regarding the actionable positive res	18 months

Collaborators and Investigators

• Sponsor: Methodist Health System
• Investigators: Principal Investigator: Andrew Karpisek, MD, Methodist Health System

Study record dates

Study Major Dates

• Study Start (Actual): January 31, 2024
• Primary Completion (Estimated): January 31, 2027
• Study Completion (Estimated): January 31, 2028

Study Registration Dates

• First Submitted: March 26, 2024
• First Submitted That Met QC Criteria: March 18, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 20, 2026
• Last Update Submitted That Met QC Criteria: March 18, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Sepsis; Systemic Inflammatory Response Syndrome; Inflammation; Bacterial Infections; Bacterial Infections and Mycoses; Pathological Conditions, Signs and Symptoms; Bacteremia
• Other Study ID Numbers: 057.PHA.2023.A

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No