Antimicrobial Stewardship in Emergency Department Settings

Introduction to CUS Framework

The CUS framework, as recommended by the American College of Emergency Physicians, is a structured communication tool used to escalate patient safety concerns, including identifying potential safety issues, expressing discomfort, and invoking patient safety 1, 2

High rates of ED overcrowding and rapid patient turnover create pressure for quick decision-making, often without consultation, which can lead to inappropriate antibiotic use 1, 2
The initial antibiotic choice made in the ED significantly influences what therapy is continued in the inpatient setting, representing a critical opportunity for stewardship 1, 2, 4
Medical liability concerns and requirements to satisfy quality measures have been shown to be associated with antibiotic overuse in the ED setting 2, 4

An estimated 142,500 ED visits annually are for adverse events associated with systemic antibiotics, with nearly 80% due to allergic reactions 5, 6
Reducing unnecessary or inappropriate antimicrobial use is imperative not only for decreasing antimicrobial resistance but also for individual patient safety 1, 2, 5
The ED sits at the interface of inpatient and outpatient settings, making ED practitioners uniquely positioned to impact antimicrobial stewardship in both locations 1, 2, 6