Dataset Information

Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback.

ABSTRACT:

Objective

To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED).

Design

A controlled before-and-after study.

Setting

The study was conducted in 5 adult EDs at teaching and community hospitals in a health system.

Patients

Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for a non-respiratory condition for which antibiotics are or may be warranted were excluded.

Interventions

After a baseline period from January 2016 to March 2018, 3 EDs implemented a feedback intervention with peer comparison between April 2018 and December 2019 for attending physicians. Also, 2 EDs in the health system served as controls. Using interrupted time series analysis, the inappropriate ARI prescribing rate was calculated as the proportion of antibiotic-inappropriate ARI encounters with a prescription. Prescribing rates were also evaluated for all ARIs. Attending physicians at intervention sites received biannual e-mails with their inappropriate prescribing rate and had access to a dashboard that was updated daily showing their performance relative to their peers.

Results

Among 28,544 ARI encounters, the inappropriate prescribing rate remained stable at the control EDs between the 2 periods (23.0% and 23.8%). At the intervention sites, the inappropriate prescribing rate decreased significantly from 22.0% to 15.2%. Between periods, the overall ARI prescribing rate was 38.1% and 40.6% in the control group and 35.9% and 30.6% in the intervention group.

Conclusions

Behavioral feedback with peer comparison can be implemented effectively in the ED to reduce inappropriate prescribing for ARIs.

SUBMITTER: Jones GF

PROVIDER: S-EPMC9495637 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback.

Jones George F GF Fabre Valeria V Hinson Jeremiah J Levin Scott S Toerper Matthew M Townsend Jennifer J Cosgrove Sara E SE Saheed Mustapha M Klein Eili Y EY

Antimicrobial stewardship & healthcare epidemiology : ASHE 20211223 1

<h4>Objective</h4>To reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) by employing peer comparison with behavioral feedback in the emergency department (ED).<h4>Design</h4>A controlled before-and-after study.<h4>Setting</h4>The study was conducted in 5 adult EDs at teaching and community hospitals in a health system.<h4>Patients</h4>Adults presenting to the ED with a respiratory condition diagnosis code. Hospitalized patients and those with a diagnosis code for ...[more]

PMID: 36168488

Similar Datasets

Project description:Background The Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUIPPED) program developed an audit and feedback health information technology (IT) solution with the intent to replace the in-person academic detailing service provided by the program. The EQUIPPED dashboard provides emergency department (ED) providers with a personalized view of their prescribing performance.Objectives Here, we analyze the association between ED provider characteristics and viewership of the EQUIPPED dashboard, adding insight into strategies for addressing barriers to initial use.Methods We performed a retrospective analysis of EQUIPPED dashboard viewership among four Veterans Affairs (VA) EDs. We extracted quantitative data from user interaction logs to determine evidence of dashboard use. Provider characteristics and baseline potentially inappropriate medication (PIM) prescribing rate were extracted from the VA's Corporate Data Warehouse. Logistic regression was used to examine the association between dashboard use and provider characteristics.Results A total of 82 providers were invited to receive audit and feedback via the EQUIPPED dashboard. Among invited providers, 40 (48.7%) had evidence of at least 1 dashboard view during the 1-year feedback period. Adjusted analyses suggest that providers with a higher baseline PIM prescribing rate were more likely to use the dashboard (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.01-1.47). Furthermore, providers at ED site D were more likely to use the dashboard in comparison to the other sites (OR: 9.99; 95% CI: 1.72-58.04) and reportedly had the highest site-level baseline PIM rate.Conclusion Providers with lower PIM prescribing rates (i.e., <5%) receive communication from an integrated dashboard reminder system that they are "optimal prescribers" which may have discouraged initial attempts to view the dashboard. Site D had the highest baseline PIM rate, but further qualitative investigation is warranted to better understand why site D had the greatest users of the dashboard.

Project description:ObjectiveAt our emergency department (ED), opioid prescribing guidelines were implemented in September 2016. The opioid prescribing guidelines were adopted and revised from collective efforts and advocacy of the Michigan College of Emergency Physicians for ED-led opioid stewardship. We performed a retrospective before and after study to determine if opioid prescribing guidelines would change the use of intravenous opioids per patient and the morphine equivalent units (MEU) per patient in a suburban academic ED.MethodsA retrospective observational study was conducted at a tertiary care level 1 trauma center with an annual ED volume of ≈ 130,000 visits. All intravenous orders of fentanyl, morphine, and hydromorphone for adult patients from January 1, 2015, through December 31, 2017, were tabulated. A 3-month (August 2016-October 2016) washout period was used. Poisson and ordinary linear regression analyses were employed to evaluate any difference in number of intravenous opioids ordered before and after adoption of the guidelines. Within our opioid prescribing guidelines was also guidance for oral opioid orders within the ED and oral opioid prescriptions for discharge, although these elements were not included in this investigation.ResultsA total of 108,327 intravenous opioid orders were included in the final analysis. After adoption of the opioid prescribing guidelines, the expected number of intravenous opioids ordered dropped by 3.1% (eβ, 0.969; 95% confidence interval [CI], 0.779-1.209), and there was an additional decrease of 0.1% per month (eβ, 0.999; 95% CI, 0.990-1.010). After the adoption of opioid prescribing guidelines, the average MEU dropped by 0.3 mg (95% CI, -0.47 to -0.13), and there was decrease of 0.01 mg per month (95% CI, -0.02 to -0.004).ConclusionAfter the adoption of opioid prescribing guidelines, our analysis suggests that opioid prescribing guidelines are associated with clinically small but statistically significant changes in MEU ordered in ED. We cannot determine if this represented a continued trend of decreased opioid use or associated with the opioid prescribing guidelines.

Dataset Information

Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback.

Objective

Design

Setting

Patients

Interventions

Results

Conclusions

Publications

Improving antimicrobial prescribing for upper respiratory infections in the emergency department: Implementation of peer comparison with behavioral feedback.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets