Appropriateness of Intravenous Antibiotics Prescriptions at Hospital Discharge

Study Overview
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Brief Summary
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A quasi-experimental study was conducted among patients receiving care at the medicine units of the Maharaj Nakorn Chiang Mai Hospital to determine the appropriateness of intravenous antibiotics at hospital discharge with and without ID consultation.

Detailed Description
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The pre-intervention period was started from November 1, 2015 to April 30, 2016 (6-month period), in which the intravenous antibiotics at hospital discharge were prescribed by the primary care team. The post-intervention period was started from May 1, 2016 to February 28, 2017 (10-month period), in which the intravenous antibiotics at hospital discharge were reviewed and intervened by ID team. The appropriateness of intravenous antibiotics was assessed separately by the ID fellow and ID specialist. If disagreement occurred, the feedback to the ID fellow was performed and the decision by ID specialist was used in the final analysis of appropriateness. In post-intervention period, ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.

Official Title
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Quasi-experimental Study Comparing Intravenous Antibiotics Prescriptions at Hospital Discharge With and Without ID Consultation

Conditions
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Anti-Infectives Adverse Reaction

Intervention / Treatment
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* Procedure: ID specialist approval


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All adult patients who met the following criteria were consecutively enrolled; age≥ 15 years old and had infections at any sites and received intravenous antibiotics. Exclusion Criteria: - They were evaluated by infectious diseases specialist for appropriate antibiotics during admission

Ages Eligible for Study
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Minimum Age: 15 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: pre-intervention period<br>The charts of patients who were prescribed intravenous antibiotics at hospital discharge were reviewed. Appropriateness of intravenous antibiotics was assessed by ID specialists. | |
| Experimental: post-intervention period<br>The intervention is the charts of patients who were prescribed intravenous antibiotics at hospital discharge by the primary team were prospectively reviewed and intervened by ID team (ID specialist approval) | Procedure: ID specialist approval<br>* Appropriateness of intravenous antibiotics ordered by the primary team was assessed by ID specialist. ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics. Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The proportion of appropriateness of intravenous antibiotics prescriptions at hospital discharge between groups | To calculate the number of antibiotic prescriptions at hospital discharge over the total number of prescriptions, comparing between pre-and post-intervention period. | 16 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The costs of antibiotics for the course of treatment | To compare the cost of antibiotics for the course of treatment between the 2 periods | 16 months | 
| Clinical improvement at 1 week | To calculate the number of patients who had clinical improvement at 1 week over the total number of patients in each period, comparing between the 2 periods | 1 week | 
| Readmission within 30 days, length of hospital stay | To calculate the number of patients who were readmitted within 30 days over the total number of patients in each period, comparing between the 2 periods | 30 days | 
| Length of hospital stay | To calculate the length of hospital stays in days between 2 periods | 60 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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appropriateness, outpatient antimicrobial therapy, intravenous antibiotics