Algorithm-Driven Antibiotic Stewardship Intervention Reduces Inappropriate Broad-Spectrum Antibiotic Prescribing in Pneumonia and UTI Patients

Core Concepts

An algorithm-driven risk assessment embedded in an electronic health record (EHR) helped clinicians significantly reduce inappropriate broad-spectrum antibiotic prescribing for patients with pneumonia and urinary tract infections (UTIs).

Abstract

The content describes two related randomized control trials that evaluated the impact of an electronic health record (EHR)-based antibiotic stewardship intervention called INSPIRE (Intelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection). The trials were conducted across 59 hospitals owned by HCA Healthcare and involved over 200,000 adult patients with non-life-threatening pneumonia or UTIs.
The key highlights are:

The intervention group received educational materials, quarterly coaching calls, prospective antibiotic use evaluations, and an EHR prompt that suggested a standard-spectrum antibiotic if the patient's risk of having a multidrug-resistant organism (MDRO) was less than 10%.
The control group received routine antibiotic activities without the INSPIRE intervention.
For the UTI group, broad-spectrum antibiotic prescribing rates dropped by 17.4% in the intervention group compared to the control group.
For the pneumonia group, broad-spectrum antibiotic prescribing rates dropped by 28.4% in the intervention group compared to the control.
The studies showed similar safety outcomes between the control and intervention groups.
The researchers believe the EHR prompt was the main driver of the reduction in inappropriate broad-spectrum antibiotic use.

Stats

"Prescribing rates were based on the number of days a patient received a broad-spectrum antibiotic during the first 72 hours of hospitalization."
"For the UTI intervention group, rates dropped by 17.4% (rate ratio, 0.83; 95% CI, 0.77-0.89; P < .001), and 28.4% reduction in the pneumonia group (rate ratio, 0.72; 95% CI, 0.66-0.78; P < .001)."

Quotes

"When a patient comes in with pneumonia or a UTI, it's precisely because we are concerned that our patients have a multidrug-resistant organism that we end up using broad-spectrum antibiotics."
"What physicians have been needing is something to hang their hat on, to be able to say, 'Okay, well, this one's a low-risk person.'"
"In antibiotic stewardship, we have learned not only that doctors want to do the right thing, but that we as stewards need to make it easy for them do the right thing."
"The prompt 'is your easy button.' The researchers made it simple, fast, and straightforward, so people don't have to think about it too much."

Key Insights Distilled From

Electronic System Slashes Antibiotic Use

by Brittany at www.medscape.com 04-24-2024

https://www.medscape.com/viewarticle/automated-patient-risk-assessment-lowers-antibiotic-2024a1000801

Deeper Inquiries

How can the INSPIRE intervention be further refined and optimized to achieve even greater reductions in inappropriate antibiotic prescribing?

The INSPIRE intervention can be further refined and optimized by incorporating more personalized risk assessment factors into the algorithm. This could include factors such as recent travel history, previous antibiotic use, and specific comorbidities that may increase the risk of multidrug-resistant infections. Additionally, real-time data integration from microbiology reports and antimicrobial resistance patterns can enhance the accuracy of the risk assessment and prompt recommendations. Continuous feedback mechanisms and regular updates to the algorithm based on emerging resistance patterns can also improve the effectiveness of the intervention over time.

What are the potential barriers or challenges to widespread adoption of similar EHR-based antibiotic stewardship interventions in healthcare systems?

One potential barrier to widespread adoption of EHR-based antibiotic stewardship interventions is the initial cost and resource investment required for implementation. Healthcare systems may face challenges in integrating the new system with existing EHR platforms and ensuring seamless workflow integration for clinicians. Resistance from healthcare providers who are accustomed to traditional prescribing practices and concerns about the reliability and accuracy of the algorithm-generated recommendations could also impede adoption. Additionally, data privacy and security concerns related to the sharing of patient information within the EHR system may pose challenges to widespread implementation.

How might the insights from this study on leveraging technology to support antibiotic stewardship be applied to other areas of healthcare to improve clinical decision-making and patient outcomes?

The insights from this study on leveraging technology for antibiotic stewardship can be applied to other areas of healthcare by developing similar algorithm-driven interventions for different clinical scenarios. For example, similar risk assessment algorithms could be designed to optimize the use of other medications, diagnostic tests, or treatment protocols based on individual patient characteristics and disease profiles. By integrating real-time data analytics and decision support tools into EHR systems, healthcare providers can make more informed and evidence-based decisions, leading to improved clinical outcomes and patient safety across various medical specialties. This approach can help standardize care practices, reduce variability in treatment decisions, and enhance overall quality of care delivery.