1012. Impact of an Innovative Smartphone “App” on Intensive Care Unit (ICU) Antimicrobial Utilization Across a Large Metropolitan Health Region in Canada: an Interrupted Time Series Analysis
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Calgary ID Week Poster (final).pdf (3.3 MB)
  • Background: SpectrumMD is a customizable stewardship smartphone app that offers algorithmic decision support based on clinical guidelines and local microbiology data. The app was introduced to all ICU prescribers across a large metropolitan health region followed by an interrupted time series analysis (ITSA) to evaluate the impact on ICU antimicrobial utilization (AMU).

    Methods: SpectrumMD was launched 1/11/2013 to ICU prescribers with monthly educational sessions. Penetration of the app was tracked with Flurry Analytics™, a post-intervention survey, and via session attendance. An uncontrolled before-after intervention ITSA (SPSS v19.0) was performed to compare AMU in the 12 months pre- and post-intervention (allowing a 3 month wash-in period) using daily defined doses/100 patient days. Patient demographics, central line associated bloodstream infection (CLABSI) and influenza rates were analyzed for both time periods. Student’s t test was used for continuous variables and two-tailed χ2 or Fishers exact as appropriate for categorical variables.

    Results: Patient characteristics were similar between the pre- (n=2867) and post-intervention (n=2717) groups, including age (x 56.9 vs. 56.3 years), admission APACHE (19.7 vs. 19.6), and immunosuppression (15% vs. 16%), as were rates of CLABSI and influenza. Post wash-in there were 634 active SpectrumMD users within the health region, which increased to 1145 during the post-intervention period, and 76% (54/71; response rate 34%) of survey respondents reported using the app during their ICU rotation. There was no statistically significant change in overall AMU between the time periods. Agent-specific analysis revealed a trend toward decreased anti-pseudomonal utilization (slope change parameter -0.983; p=0.07). Of 64 respondents, 70% agreed this app changed their antimicrobial prescribing practices while 89% would recommend it to colleagues.

    Conclusion: SpectrumMD was a widely accepted intervention that yielded positive user feedback. Though there was no significant reduction in overall AMU, a trend toward decreased anti-pseudomonal agent use may represent more appropriate antimicrobial prescribing. Further longitudinal analysis is required to assess the impact of this promising app.

    Stephen Robinson, MD1,2, Paul Campsall, MD1,2,3, Elizabeth Parfitt, MD1,2,3, John Conly, MD1,2, Bruce Dalton, BScPharm, PharmD4, William Stokes, MD1,2, Barry Kushner, BScPharm4, Stephen Vaughan, MD1,2, Bayan Missaghi, MD1,2, Vikas Chaubey, MD1, Daniel Gregson, MD1,5,6 and Dan Zuege, MD1,2, (1)University of Calgary, Calgary, AB, Canada, (2)Alberta Health Services, Calgary Zone, Calgary, AB, Canada, (3)University of British Columbia, Kamloops, BC, Canada, (4)Pharmacy, Alberta Health Services, Calgary Zone, Calgary, AB, Canada, (5)Snyder Institute for Chronic Diseases, Calgary, AB, Canada, (6)Calgary Laboratory Services, Calgary, AB, Canada

    Disclosures:

    S. Robinson, None

    P. Campsall, None

    E. Parfitt, None

    J. Conly, Alberta Health Services (AHS): Employee , John Conly receives a stipend from AHS for his medical role in antimicrobial stewardship

    B. Dalton, Alberta Health Services (AHS): Employee , Bruce Dalton had roles in both implementation and evaluation of this program and receives remuneration for antimicrobial stewardship activities. Potential risk of bias exists in this evaluation as positive results could also be career advancing.

    W. Stokes, None

    B. Kushner, None

    S. Vaughan, None

    B. Missaghi, None

    V. Chaubey, None

    D. Gregson, None

    D. Zuege, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.