Methods: Pragmatic clinical study in a 339-bed hospital located in Ontario, Canada. Starting on April 1, 2013 and ending March 31, 2015, all consecutive immune-competent adult patients (>18 years old) admitted to hospital with pneumonia were eligible for enrollment. The ASP intervention was a prospective audit and feedback recommendation implemented in a non-randomized stepped wedge design across 4 wards and modeled as a time-dependent variable. The primary outcome was time to hospital discharge and secondary outcomes included time to antibiotic discontinuation and composite of 30-day re-admission or all-cause mortality. Effect on outcomes was evaluated using survival (time to discharge and antibiotic discontinuation) and logistic (30-day re-admission and all-cause mortality) regression analyses.
Results: Complete data was available for 763 patients. Primary outcome was observed in 196 (82%) control and 402 (77%) intervention patients. Competing risks survival analysis of the primary outcome demonstrated a sub-distribution hazard ratio (SHR) of 1.08 (95% CI 0.80, 1.46) for patients exposed to the intervention. There was significant effect on days and duration of antimicrobial therapy (SHR 1.29 (95% CI 1.10, 1.52) and 1.65 (95% CI 1.42, 1.93), respectively). A SHR > 1 should be interpreted as a reduction in time to hospital discharge or antibiotic discontinuation. There was no significant effect on 30-day re-admission or all-cause mortality (OR 0.79 (95% CI 0.49, 1.29)).
Conclusion: A prospective audit and feedback ASP intervention did not reduce length of hospital stay in patients with pneumonia despite reducing overall antibiotic utilization.
J. Beyene, None
M. Smieja, None
L. Thabane, None