# Less is more: evaluating the impact of transitions of care pharmacist-led optimization on discharge antibiotic therapy duration in the emergency department

## TL;DR

Pharmacists reviewing antibiotic prescriptions in the emergency department helped reduce unnecessary antibiotic use, saving 155 days of treatment and showing high provider acceptance.

## Contribution

This study demonstrates the effectiveness of pharmacist-led interventions in optimizing antibiotic duration for ED discharge patients.

## Key findings

- Pharmacists reviewed 157 prescriptions and saved 155 antibiotic days.
- Provider acceptance rate was 76.5% for pharmacist recommendations.
- 21% of prolonged durations were due to uncounted ED antibiotic doses.

## Abstract

Patients discharged from emergency departments (ED) with antibiotics for common infections often receive unnecessarily prolonged durations, representing a target for transition of care (TOC) antimicrobial stewardship intervention.

This study aimed to evaluate the effectiveness of TOC pharmacists’ review on decreasing the duration of discharge oral antibiotics in patients discharged from the ED at an academic medical center. Pharmacist interventions were guided by an antibiotic duration of therapy guidance focused on respiratory, urinary, and skin infections developed and implemented by the antimicrobial stewardship program. Pharmacist interventions from January 27, 2023, to December 29, 2023, were analyzed to quantify the total number of antibiotic days saved and the percentage of provider acceptance.

The ED TOC pharmacists reviewed a total of 157 oral antibiotic prescriptions. 86.6% percent of the reviews required pharmacist interventions. The most common indications for the discharge antibiotics were urinary tract infections (50.0%) and skin infections (23.4%). The total number of antibiotic days saved was 155 days with the provider acceptance rate of 76.5%. In 21% of cases, providers did not count the antibiotic doses administered in the ED, contributing to unnecessarily prolonged duration. 10.2% of patients re-presented to the ED while 6.4% of patients were hospitalized within 30 days of index ED discharge.

The transitions of care pharmacist-led intervention was successful in optimizing the duration of discharge oral antibiotics in the ED utilizing prospective audit and feedback based on institutional guidance. The ED represents a high-yield setting for TOC-directed antimicrobial stewardship.