Dataset Information

A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization.

ABSTRACT:

Objectives

To determine whether face-to-face prompting of critical care physicians reduces empirical antibiotic utilization compared to an unprompted electronic checklist embedded within the electronic health record.

Design

Random allocation design.

Setting

Medical ICU with high-intensity intensivist coverage at a tertiary care urban medical center.

Patients

Two hundred ninety-six critically ill patients treated with at least 1 day of empirical antibiotics.

Interventions

For one medical ICU team, face-to-face prompting of critical care physicians if they did not address empirical antibiotic utilization during a patient's daily rounds. On a separate medical ICU team, attendings and fellows were trained once to complete an electronic health record-embedded checklist daily for each patient, including a question asking whether listed empirical antibiotics could be discontinued.

Measurements and main results

Prompting led to a more than four-fold increase in discontinuing or narrowing of empirical antibiotics compared to use of the electronic checklist. Prompted group patients had a lower proportion of patient-days on which empirical antibiotics were administered compared to electronic checklist group patients (63.1% vs 70.0%, p = 0.002). Mean proportion of antibiotic-days on which empirical antibiotics were used was also lower in the prompted group, although not statistically significant (0.78 [0.27] vs 0.83 [0.27], p = 0.093). Each additional day of empirical antibiotics predicted higher risk-adjusted mortality (odds ratio, 1.14; 95% CI, 1.05-1.23). Risk-adjusted ICU length of stay and hospital mortality were not significantly different between the two groups.

Conclusions

Face-to-face prompting was superior to an unprompted electronic health record-based checklist at reducing empirical antibiotic utilization. Sustained culture change may have contributed to the electronic checklist having similar empirical antibiotic utilization to a prompted group in the same medical ICU 2 years prior. Future studies should investigate the integration of an automated prompting mechanism with a more generalizable electronic health record-based checklist.

SUBMITTER: Weiss CH

PROVIDER: S-EPMC3812385 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Publications

A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization.

Weiss Curtis H CH Dibardino David D Rho Jason J Sung Nina N Collander Brett B Wunderink Richard G RG

Critical care medicine 20131101 11

<h4>Objectives</h4>To determine whether face-to-face prompting of critical care physicians reduces empirical antibiotic utilization compared to an unprompted electronic checklist embedded within the electronic health record.<h4>Design</h4>Random allocation design.<h4>Setting</h4>Medical ICU with high-intensity intensivist coverage at a tertiary care urban medical center.<h4>Patients</h4>Two hundred ninety-six critically ill patients treated with at least 1 day of empirical antibiotics.<h4>Interv ...[more]

PMID: 23939354

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Dataset Information

A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization.

Objectives

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

Publications

A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization.

Similar Datasets

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