Prospective audit-feedback is the primary strategy adopted by our hospital antibiotic stewardship program (ASP). It is labor-intensive and successful uptake relies on the visibility of the written intervention note. A rapid notification system (RNS), whereby the physical note is replaced by an electronic document followed by immediate prescriber alert through text messaging, was recently implemented. We seek to quantify the impact of this initiative on patient outcomes and ASP resource utilization.
Interventions to discontinue, de-escalate or switch from intravenous to oral antibiotics in the pre-implementation (P1: January 2016 – February 2017) and post-implementation (P2: March 2017 – February 2018) periods were identified from the ASP database. Same-day intervention acceptance rate (IAR), duration of antibiotic therapy (DOT) and hospital length of stay (LOS), measured from day of intervention to discharge, were compared. Manpower time saved from having to perform next-day intervention follow-up (15mins/intervention) was calculated.
A total of 1904 (11.4%) and 1311 (12.4%) interventions of 16723 and 10545 antibiotic audits were made during P1 and P2 respectively. There were no significant differences in antibiotic or intervention types between both periods – piperacillin-tazobactam (85.4%) was most common, followed by meropenem (11.4%); intervention to discontinue antibiotic (68.4%) was most frequent. Implementation of RNS led to a pronounced 2.5-fold increase in same-day IAR (19.3% vs. 47%, p<0.01). Potential savings in ASP manpower was estimated at 75 hours/year. Overall improvement in IAR at 48-hours was also observed (79.2% vs. 82.5%, p=0.02). Patients with ASP interventions accepted on the same day had significantly shorter DOT (4.4 vs. 5.4 days, p<0.01) but not LOS (13.4 vs. 11.6 days, p=0.08). 30-day infection-related mortality rates were similar across the 2 periods (3.3% vs. 3.3%).
Early alert to ASP interventions can strengthen impact of ASP in reducing unnecessary antibiotic use without compromise in patient safety. ASPs, particularly those serving large and busy hospitals, should consider having a RNS in place to improve program efficiency and visibility.
S. S. L. Tang,
D. Y. C. Yii, None
A. L. Kwa, None
P. Chlebicki, None
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