Background: Quality of care has been shown to vary depending time of day or day of the week, gender, and experience of caregivers. To aid antimicrobial stewardship efforts we aimed to study how these factors influence appropriateness of antimicrobial prescribing.
Methods: We performed prospective point-prevalence surveys of antimicrobial appropriateness on all clinical wards of a tertiary care medical center, and collected information about the factors above. We analyzed associations between these factors and antimicrobial appropriateness, followed-up by a survey among hospital physicians to enquire about their interpretation of the results.
Results: We included 447 antimicrobial prescriptions by 161 physicians prescribed for 350 patients. We found that appropriateness of antimicrobial prescribing in the morning was significantly lower compared to the afternoon and evening/night (49% vs. 68% vs. 65%); odds ratioÕs (OR) with morning as reference: 2.49 (95% confidence interval (CI) 1.34-4.63) and 2.16 (95% CI 1.10-4.24) respectively. First year residents performed significantly worse than their more experienced colleagues: 49% vs. 67%, OR 1.99 (95% CI 1.05-3.79). We found no significant effects for gender and office hours vs. non-office hours (Figure 1). Theme-analysis of our survey results suggested there is a suboptimal prescribing environment in the morning due to the morning rush, less supervisory support, and lower availability of diagnostic results and advice from consulting specialties.
Conclusion: Appropriate antimicrobial prescribing in a hospital seems most difficult in mornings and for inexperienced physicians. We recommend introducing a "prescribing time out" in the morning with availability of microbiological results and supervision. This could possibly overcome this morning dip in appropriate prescribing.
E. Peters, None
M. Kramer, None
M. Van Agtmael, None
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