Impact of 24-hour pharmacy call response on time to antibiotics in open fractures.

Purpose: Open fractures are associated with significant morbidity after trauma, which is driven, in part, by infection. Current literature and guidelines recommend that this patient population receive antimicrobial prophylaxis within 1 hour of emergency department (ED) arrival to minimize the risk of infection. The primary aim of this study was to investigate whether the addition of a trauma response to a pharmacy resident on-call program resulted in antibiotic administration within 1 hour of presentation to a higher proportion of patients with open fractures.

Methods: This was a retrospective, observational, quasi-experimental analysis that was conducted at an academic medical facility with a level 1 trauma center for patients presenting to the ED from January 2019 to December 2020 (preimplementation period) and from January 2021 to December 2022 (postimplementation period). Patients were included if they were 18 years of age or older and presented to the ED with an open fracture(s). Patients with independent fractures of fingers and those who died in route to or in the ED were excluded. The primary outcome was the proportion of patients with antibiotic administration within 1 hour of ED presentation for patients with open extremity fractures.

Results: A total of 292 patients met the eligibility criteria (49% in the preimplementation group and 51% in the postimplementation group). Patients were predominantly male (61% vs 58%), with an overall median age of 46 years. Following implementation of the on-call pharmacy resident trauma response, a significantly higher proportion of patients received antibiotics within 1 hour of presentation (70% vs 83%; P = 0.019). The median (interquartile range) time to antimicrobial administration was also significantly shorter in the postimplementation group (31 [16-68] minutes vs 19 [10-50] minutes; P = 0.005).

Conclusion: The addition of a 24-hour on-call pharmacy resident response in the ED was associated with improved antibiotic administration within 1 hour of presentation in patients with open fractures.