Program Schedule

1329
Impact of an Antimicrobial Order Auto-Stop on Clinical Outcomes at a Single Institution

Session: Oral Abstract Session: Advancing the Science of Antibiotic Stewardship
Saturday, October 11, 2014: 11:30 AM
Room: The Pennsylvania Convention Center: 107-AB

Background:   In January 2011, an electronic health record (EHR) based auto-stop feature, facilitated by mandatory antimicrobial order end dates, was enabled at our institution as part of an established Antimicrobial Stewardship Program (ASP). Previously, restricted antimicrobial orders remained as current medications in the EHR after the ASP-approved length of therapy (typically 48 hours) was complete. However another approval was required for the pharmacy to dispense more medication. Following the auto-stop implementation, the order expired from the current medications list after completion of the approved length of therapy.

Methods:   Repeated cross-sectional study to assess the impact of auto-stop on clinical outcomes of hospitalized children. Data on patients discharged between 2/1/2009 and 1/31/13 were obtained from the Pediatric Health Information System, a database containing medication billing data. A sub-cohort of patients with bacteremia was also identified using microbiology laboratory data. Outcomes included all-cause in-hospital mortality, readmission within 14-days and 30 days of discharge, and length of stay. Model-based pre-post comparisons were standardized by patient and clinical characteristics and accounted for clustering by physician.

Results:   During the 4-year study period, 26300 patients received restricted antibacterials. In-hospital all-cause mortality, 14-day and 30-day readmission, and length of stay were not significantly different before and after implementation of the auto-stop in all patients or the sub-cohort of children with bacteremia (Table).

Conclusion:   Implementation of an EHR-based antimicrobial auto-stop feature did not significantly impact clinical outcomes in hospitalized children. Future studies should examine the effects of this EHR-based tool on antimicrobial use.

 

Table. Standardized clinical outcomes for patients receiving restricted antibiotics

 

 

All Patients

(n=26300)

Bacteremia Patients

(n=1405)

 

Pre

Post

p-value

Pre

Post

p-value

 

Standardized Rate (%)

 

 

 

 

 

 

 

In-hospital all-cause mortality

2.0

1.9

0.358

8.0

6.8

0.315

 

Readmission in 14 days

7.4

7.5

0.778

6.2

4.8

0.294

 

Readmission in 30 days

15.4

16.4

0.057

17.4

17.2

0.947

 

 

 

 

 

Standardized Length of Stay (days)

11.7

12.0

0.183

44.7

47.6

0.350

 

 

Rachael Ross, MPH, The Children's Hospital of Philadelphia, Philadelphia, PA, Talene A. Metjian, PharmD, Department of Antimicrobial Stewardship, Children's Hospital of Philadelphia, Philadelphia, PA, Jonathan Beus, MD, Children's Hospital of Philadelphia, Philadelphia, PA, Theoklis Zaoutis, MD, MSCE, Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, the Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA and Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA

Disclosures:

R. Ross, None

T. A. Metjian, None

J. Beus, None

T. Zaoutis, Merck: Investigator, Research grant
Merck: Consultant, Consulting fee
Pfizer: Consultant, Consulting fee
Astellas: Consultant, Consulting fee

J. S. Gerber, None

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