1597. Automated Metrics for Potential Adverse Outcomes in Pediatric Antimicrobial Stewardship
Session: Poster Abstract Session: Stewardship: Pediatric Antimicrobial Stewardship
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • Safety Metrics Poster.pdf (245.7 kB)
  • Background: Many prescribers may question the safety of restricting antibiotic use at their own institution. Measurement of potential adverse outcomes relevant to antimicrobial stewardship may increase the acceptability of stewardship interventions.  

    Methods: Antibiotic prescribing, admit/discharge/transfer (ADT) data, vital sign (VS) trends, white blood cell counts (WBC), microbiology antibiotic susceptibility results (ASR), and medication administration record (MAR) data were reviewed for 2620 patients hospitalized at Lurie Children’s Hospital from April 2013 to March 2017. Metrics were created using discrete data elements derived from the electronic health record (EHR). The sensitivity (to detect an adverse outcome) and specificity (to avoid false detection of an adverse outcome) were measured in comparison to manual review of the medical record. Data were presented to 50 pediatricians and pediatric subspecialists who were asked to rate (Likert scale 1-5) the perceived importance of the metrics for patient safety and usefulness of the metrics for their prescribing.

    Results: The metrics, data elements, sensitivity, specificity, and ratings by prescribers for importance and usefulness are listed below.

    Conclusion: Metrics derived from the EHR can offer automated surveillance of infection-related adverse outcomes relevant to antimicrobial stewardship. At the institutional level, these metrics are a potential tool to ensure the safety and acceptability of stewardship interventions.

    Potential Adverse Outcome

    Data Elements

    Number of Episodes Reviewed

    Sensitivity

    Specificity

    Importance

    (Mean)

    Usefulness

    (Mean)

    Isolated organism not susceptible to empiric therapy for positive culture at sterile body site

    Pharmacy orders

    ASR

    800

    86%

    85%

    4.8

    4.3

    Disagreement between rapid diagnostic test result and culture result

    Pharmacy orders

    ASR

    430

    95%

    81%

    4.2

    4.5

    Antibiotic restart within 7 days after initial discontinuation

    MAR
    Abnormal WBC

    Fever>38 F

    1200

    81%

    75%

    3.8

    3.6

    IV restarts or readmissions after IV to PO conversion

    ADT

    MAR

    Abnormal WBC

    Fever>38 F

    2100

    87%

    94%

    3.8

    3.4

    Sameer Patel, MD, MPH, Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, Caroline Reuter, MD, Pediatric Infectious Disease, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, Rupal Patel, PharmD, Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, Larry Kociolek, MD, MSCI, Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL and Roderick Jones, MPH, Data Analytics and Reporting, ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO, CHICAGO, IL

    Disclosures:

    S. Patel, Merck Pharmaceuticals: Investigator , Research grant

    C. Reuter, None

    R. Patel, Merck Pharmaceuticals: Investigator , Research grant

    L. Kociolek, Merck Pharmaceuticals: Investigator , Research grant

    R. Jones, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.