Over 60% of hospitalized patients receive antibiotics. Unfortunately, up to 50% of inpatient antibiotic use has been judged as inappropriate. With the increasing presence of hospitalists, combined with their focus on patient safety and quality improvement, efforts designed to improve antibiotic use in the hospital would benefit if they are focused on and endorsed by hospitalists. We sought to identify, test and quantify the impact of interventions designed to improve antibiotic use in the hospital that can be incorporated into the work‐flow of hospitalists.
In partnership with the Institute for Healthcare Improvement (IHI) and the Center for Disease Control and Prevention (CDC), we identified three practices associated with appropriate antibiotic use: 1) Documentation of antibiotic indication, day of therapy, and expected duration at the point of care; 2) Antibiotic “time‐out” with a clinical pharmacist three times weekly to review the need for antibiotics and de‐escalation opportunities; and 3) Awareness of guideline recommended duration of treatment. These practices were evaluated at 5 U.S. hospitals. For this analysis we evaluated the implementation of two of these practices using physician education, multidisciplinary rounding, and financial incentives on the hospitalist service at an academic medical center. Before and after implementation, physician antibiotic documentation in progress notes, discharge summaries, and service sign‐outs was evaluated. Changes to antibiotic regimens resulting from antibiotic time‐outs were quantified and characterized.
During a 2 week pilot period, 46% (251/545) of sampled patients were on antibiotics. Documentation of all antibiotic components (indication, day of treatment, and expected duration) significantly improved from baseline after the intervention; 4% (2/48) vs. 51% (36/70) for progress notes, 10% (2/20) vs. 84% (62/74) for discharge summaries, and 18% (8/44) vs. 50% (68/135)for service sign‐outs (P<0.001 for all comparisons). In total, 582 antibiotic time‐outs were evaluated, a quarter of which resulted in changes to antibiotic regimens, and of all changes made, 27% resulted in discontinuation of antibiotics during the time‐out (See Figure).
Improved antibiotic documentation and regular antibiotic time‐outs can be integrated into hospitalists’ work‐flow. Many of the strategies used to incorporate these practices can be easily adopted at other institutions. The antibiotic time‐outs resulted in significant changes to the antibiotic regimens of hospitalized patients. Further evaluation of these interventions on overall antibiotic use is needed.
To cite this abstract:Rohde J, Mack M, Tupps M, Arnold P, Jacobsen D, Flanders S. A Hospitalist‐Centered Effort to Improve Antibiotic Use in Hospitalized Patients. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 133. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/a-hospitalistcentered-effort-to-improve-antibiotic-use-in-hospitalized-patients/. Accessed September 16, 2019.