Pharmacist-led Transitions of Care Intervention to Address Infectious Disease Tests Pending at Discharge (TPAD).

BACKGROUND

Infectious disease test results frequently finalize after hospital discharge, and many are clinically actionable. Standardized workflows for reviewing these results remain limited. Although pharmacist-led culture follow-up is well established in emergency departments, evidence evaluating inpatient transitions-of-care models is sparse. This study assessed the impact of a pharmacist-led service on outpatient antimicrobial appropriateness and clinical outcomes.

METHODS

We conducted a single-center, retrospective pre-post study at a community hospital comparing patients discharged with pending infectious disease test results before and after service implementation. The intervention included thrice-weekly review of finalized results, clinical assessment, prescriber communication, outpatient prescription changes, and patient counseling. The primary outcome was appropriate outpatient antimicrobial therapy 7 days after discharge. Secondary outcomes included time to appropriate therapy among patients requiring prescription modification and 30-day infection-related outcomes. Multivariable logistic regression adjusted for urine culture source, discharge service, and inpatient infectious diseases consultation. Time-to-therapy analyses used Kaplan-Meier and Cox proportional hazards.

RESULTS

Among 191 patients (93 preintervention; 98 postintervention), appropriate antimicrobial therapy at 7 days increased from 69% to 92%. Adjusted analyses showed a 21.3% higher predicted probability of appropriate therapy (95% CI, 10.6-32.0). Among patients requiring prescription changes (n = 63), median time to appropriate therapy improved from 7 to 4 days, with a 5-fold higher rate of achieving appropriate therapy (hazard ratio, 5.09; 95% CI, 2.13-12.18). Thirty-day outcomes were similar between groups.

CONCLUSIONS

A pharmacist-led service improved antimicrobial appropriateness and accelerated transitions to appropriate therapy, supporting pharmacist-driven follow-up as an effective stewardship strategy.