1418. Evaluation of a Clinical Decision Support System for Antimicrobial De-escalation at a Large Academic Medical Center
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
  • TheraDoc De-escalation IDWeek 2015 Final.pdf (124.7 kB)
  • Background: Clinical decision support systems (CDSS) are often components of antimicrobial stewardship programs (ASPs).  TheraDoc™, a CDSS, has both pre-built as well as customizable stewardship alerts. Prior studies have demonstrated clinical benefit but also a low rate of actionable alerts (24-36%). A pilot study was undertaken to assess the time and value of the CDSS, both pre-built and custom built alerts, for ASP interventions with a focus on de-escalation.

    Methods: 15 different types of alerts (1 pre-built and 14 custom) were chosen for the initial ASP review.  Pre-intervention, alerts were generated retrospectively from March 1-31, 2014.  Post intervention, alerts were reviewed for ASP intervention by a pharmacist in real-time from May 19-June 20, 2014.  Data collection included the total actionable (an intervention was or could have been attempted), acceptance of recommendation, and time spent for each type of alert.  For de-escalation alerts, time to de-escalation to a more narrow spectrum agent was collected.

    Results: 749 alerts were evaluated (373 pre) and (376 post).  The primary service was medical (52% vs. 57%) and there was an infectious diseases consult in 48% and 47% of alerts in pre vs. post groups, respectively.  Overall, 306 (41%) alerts were actionable (173 pre and 133 post).  Custom built alerts were more actionable (53/95, 56%) vs. pre-built alerts (253/614, 41%), p<0.01.  The most common alert types were drug-bug mismatch, custom de-escalation, and drug-interaction alerts. In the post group, an intervention was attempted in 97% of actionable alerts and 70% (91/131) of interventions were accepted.  The average time spent per alert was 7 minutes, with actionable alerts taking average 15 min and non-actionable 6 min, p<0.01. For de-escalation alerts, time to de-escalation was 28.8 hours in pre vs. 4.7 hours in the post group, p<0.01. 

    Conclusion: ASP programs evaluating CDSS should consider customizing alerts to improve rate of actionable alerts and minimize time spent on non-actionable alerts.  Overall, the use of CDSS as part of an ASP helped identify targets for de-escalation and decreased broad spectrum antimicrobial usage.

    Elizabeth Neuner, PharmD1, Seth Bauer, Pharm.D.2, Riane Ghamrawi, Pharm.D.3, Alexander Kantorovich, PharmD4, Andrea Pallotta, Pharm.D.2, Jennifer Sekeres, Pharm.D.2 and Steven Gordon, MD, FIDSA, FSHEA5, (1)Department of Pharmacy, Cleveland Clinic, Cleveland, OH, (2)Pharmacy, Cleveland Clinic, Cleveland, OH, (3)Pharmacy, University Hospital, Cleveland, OH, (4)Pharmacy, Chicago State University College of Pharmacy, Chicago, IL, (5)Infectious Disease, Cleveland Clinic, Cleveland, OH


    E. Neuner, None

    S. Bauer, None

    R. Ghamrawi, None

    A. Kantorovich, None

    A. Pallotta, None

    J. Sekeres, None

    S. Gordon, 3M: Scientific Advisor , Consulting fee
    Thoratec: Scientific Advisor , Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.