Discharging Patients With Pending Microbiology Cultures: A Narrative Review of Safety and Best Practices

Abstract

Discharging patients with pending microbiology culture results from the hospital has become a common practice aimed at improving hospital throughput and reducing length of stay. One of the main contributors to prolonged hospitalization is the delay in receiving finalized culture results, especially when patients are clinically stable and ready for discharge. Consequently, many hospitals have explored strategies to safely discharge patients before culture results are finalized. While this approach may help alleviate bed shortages and reduce healthcare costs, it raises important patient safety concerns. Finalized culture results may reveal pathogens or resistance patterns that necessitate changes in antimicrobial therapy. Without timely review and action, these findings can lead to missed diagnoses, suboptimal treatment, or avoidable readmissions. This narrative review synthesizes the current evidence on the safety, clinical impact, and system-level strategies associated with discharging patients with pending culture results. Studies show that 2%-11% of pending cultures in hospitalized patients require a change in clinical management, yet documentation of these pending results is often missing from discharge summaries, and follow-up responsibility is frequently unclear. Vulnerable populations, such as older adults and those discharged to subacute care facilities, are particularly at risk due to fragmented transitions and limited outpatient monitoring. Adverse outcomes in these groups include delayed therapy adjustments, inappropriate antimicrobial use, and increased healthcare utilization. To address these risks, several interventions have shown promise. These include electronic health record (EHR)-based alerts, pharmacist-led stewardship programs, and auto-populated discharge summary tools. When integrated into standardized discharge workflows and supported by institutional policy, these interventions improve follow-up rates and reduce harm. Systematic reviews of hospital discharge practices emphasize that multidisciplinary approaches, combining clinical teams, pharmacists, and care transition services, are most effective in ensuring timely review and response to finalized results. In conclusion, discharging patients with pending microbiology cultures can be safe when supported by structured systems that ensure results are reviewed and acted upon after discharge. Hospitals should implement protocols that clearly document pending tests, assign follow-up responsibility, and utilize EHR tools to facilitate communication. These strategies enhance both patient safety and operational efficiency during the vulnerable transition from inpatient to outpatient care.

Keywords: antibiotic stewardship; discharge communication; electronic medical records; hospital discharge safety; microbiology follow-up; patient safety; pending culture results; post-discharge care; quality improvement; test result management.