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.