2026 Southeastern Residency Conference

Background: Intravenous (IV) iron is an effective therapy for iron deficiency anemia, and growing evidence supports outpatient administration when clinically appropriate. Despite this, hospitalized patients frequently receive IV iron without a standardized process to ensure therapy completion after discharge. To address this gap, the adult iron replacement order set was updated to better facilitate ambulatory infusion referrals and incorporate a pharmacist consult. The consult prompts inpatient clinical pharmacists to review indication for IV iron with the ordering provider and determine whether remaining doses can be safely administered in the outpatient setting or if additional inpatient doses are medically necessary. The purpose of this study was to evaluate the impact of these order set changes on outpatient IV iron referral rates. 

Methods: This multi-center, IRB-reviewed determined exempt, retrospective cohort study evaluated adult patients receiving IV iron across four Cone Health hospitals and affiliated outpatient infusion centers. Patients with IV iron orders placed through the inpatient infusion order set during the study period were included. The primary outcome was the proportion of hospitalized patients receiving IV iron who were referred for outpatient infusion. Chi-square test was utilized to compare pre-intervention (September 17, 2024–May 12, 2025) and post-intervention (May 13, 2025–October 31, 2025) cohorts for the primary outcome. Secondary outcomes included the proportion of referred patients who received at least one outpatient IV iron dose, the proportion who completed their planned outpatient IV iron treatment course, median time from discharge to first outpatient IV iron administration, median time from discharge to first outreach for infusion scheduling, and reasons for incomplete outpatient IV iron treatment among referred patients. Descriptive statistics were used to summarize baseline characteristics. 

Results: Data on 201 patients were collected from both the pre- and postimplementation phases. During the pre-intervention period, 1,430 hospitalized patients received inpatient IV iron, with 36 patients (2.5%) referred for outpatient infusion. In the post-intervention period, 1,131 hospitalized patients received inpatient IV iron, and 168 patients (14.6%) were referred for outpatient infusion (p < 0.001).  Among referred patients, 31 of 36 patients (86.1%) in the pre-intervention group and 99 of 165 patients (60.0%) in the post-intervention group received at least one outpatient IV iron dose (p = 0.0029). Overall, 24 of 36 patients (66.7%) in the pre-intervention group and 88 of 165 patients (53.3%) in the post-intervention group completed their planned IV iron treatment course (p = 0.1445). Median time from hospital discharge to first outreach for infusion scheduling was 4 days (range 0–81) in the pre-intervention group and 3 days (range 0–30) in the post-intervention group. Median time from discharge to first outpatient IV iron administration was 13 days (range 5–91) in the pre-intervention group and 11 days (range 8–18) in the post-intervention group. The most frequently identified barriers to treatment completion were no-shows, inability to contact patients, rehospitalization, patient-directed delays, and documentation gaps. 

Conclusions: Implementation of an updated IV iron order set incorporating pharmacist review significantly increased referrals for outpatient IV iron therapy. Standardizing referral workflows at hospital discharge may improve continuity of care, support timely outpatient iron repletion, and optimize utilization of inpatient and ambulatory infusion resources.