Clinical trial NCT06338176: Optimizing the Management of Staphylococcus Aureus Bacteremia (OPTIMUS-SAB)
Official title: Optimizing the Management of Staphylococcus Aureus Bacteremia (OPTIMUS-SAB): A Stepped Wedge Clinical Trial Evaluating the Effectiveness of a Centralized S. Aureus Management Model
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Staph Aureus Bacteremia
Keywords: care pathway
infectious disease consultation
Lead sponsor: University of Alberta
Sponsor class: OTHER
Collaborators: name: Alberta Health services
First posted: 2024-03-29
Enrollment: 1800
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality rates with an incidence disproportionately higher in vulnerable populations. Management according to evidence-based care parameters, in particular Infectious Diseases (ID) consultation, is associated with improved mortality. SAB management is suboptimal in Alberta compared to other jurisdictions. An Alberta-based pilot study confirmed that timely recommendations to optimize SAB care, including ID consultation, was associated with improved adherence to all evidence-based quality-of-care indicators.

Leveraging this pilot work, the investigators aim to implement OPTIMUS-SAB, an enhanced model of the pilot, to optimize and standardize SAB management across Alberta. The implementation study will be a zone-based acute care site stepped wedge design. OPTIMUS-SAB will consist of a centralized SAB care team whom will receive automated notification of all blood cultures positive for S. aureus allowing them to review the patient's medical chart and make preliminary management recommendations according to an evidence-based care bundle.

The investigators will evaluate adherence to evidence-based SAB quality-of-care indicators before and after OPTIMUS-SAB implementation and expect this to improve with a resultant reduction in duration of bacteremia, length of stay, readmission rates, and mortality. In turn, this will translate into cost savings for the health care system.


Eligibility criteria: Inclusion Criteria:

* Age greater than 18 years at the time of hospital admission
* Confirmed S. aureus bacteremia by blood culture performed at a laboratory in Alberta, Canada
* Admitted to a designated acute care site in Alberta, Canada

Exclusion Criteria:

* The treating team believes death is imminent or inevitable .
* GCD are C-level within 48 hours of admission.
* The patient is transferred in from an out-of-province acute care center with a pre-existing SAB diagnosis.

Primary outcomes:
measure: Adherence to quality-of-care indicators
timeFrame: Within 90 days
Secondary outcomes:
measure: Length of stay
timeFrame: 180 days maximum
measure: Hospital re-admission rates
timeFrame: 90 days
measure: All-cause mortality
timeFrame: 180 days
measure: In hospital mortality
timeFrame: 90 days
measure: Costing evaluation
timeFrame: One year
measure: Implementation evaluation
timeFrame: 3 years
Other outcomes:
Locations:
city: Athabasca
country: Canada
facility: Athabasca Healthcare Centre
state: Alberta
city: Banff
country: Canada
facility: Mineral Springs Hospital
state: Alberta
city: Barrhead
country: Canada
facility: Barrhead Healthcare Centre
state: Alberta
city: Bassano
country: Canada
facility: Bassano Health Centre
state: Alberta
city: Beaverlodge
country: Canada
facility: Beaverlodge Municipal Hospital
state: Alberta
city: Black Diamond
country: Canada
facility: Oilfields General Hospital
state: Alberta
city: Bonnyville
country: Canada
facility: Bonnyville Healthcare Centre
state: Alberta
city: Bow Island
country: Canada
facility: Bow Island Health Centre
state: Alberta
city: Boyle
country: Canada
facility: Boyle Healthcare Centre
state: Alberta
city: Brooks
country: Canada
facility: Brooks Health Centre
state: Alberta
city: Calgary
country: Canada
facility: Arthur J.E. Child Comprehensive Cancer Centre
state: Alberta
city: Calgary
country: Canada
facility: Foothills Medical Centre
state: Alberta
city: Calgary
country: Canada
facility: Peter Lougheed Centre
state: Alberta
city: Calgary
country: Canada
facility: South Health Campus
state: Alberta
city: Calgary
country: Canada
facility: Tom Baker Cancer Centre
state: Alberta
city: Camrose
country: Canada
facility: St. Mary's Hospital
state: Alberta
city: Canmore
country: Canada
facility: Canmore General Hospital
state: Alberta
city: Cardston
country: Canada
facility: Cardston Health Centre
state: Alberta
city: Castor
country: Canada
facility: Our Lady of the Rosary Hospital
state: Alberta
city: Claresholm
country: Canada
facility: Claresholm General Hospital
state: Alberta
city: Coaldale
country: Canada
facility: Coaldale Health Centre
state: Alberta
city: Cold Lake
country: Canada
facility: Cold Lake Healthcare Centre
state: Alberta
city: Consort
country: Canada
facility: Consort Hospital and Care Centre
state: Alberta
city: Coronation
country: Canada
facility: Coronation Hospital and Care Centre
state: Alberta
city: Crowsnest Pass
country: Canada
facility: Crowsnest Pass Health Centre
state: Alberta
city: Daysland
country: Canada
facility: Daysland Health Centre
state: Alberta
city: Devon
country: Canada
facility: Devon General Hospital
state: Alberta
city: Didsbury
country: Canada
facility: Didsbury District Health Services
state: Alberta
city: Drayton Valley
country: Canada
facility: Drayton Valley Hospital and Care Centre
state: Alberta
city: Drumheller
country: Canada
facility: Drumheller Health Centre
state: Alberta
city: Edmonton
country: Canada
facility: Cross Cancer Institute
state: Alberta
city: Edmonton
country: Canada
facility: Glenrose Rehabilitation Hospital
state: Alberta
city: Edmonton
country: Canada
facility: Grey Nuns Community Hospital
state: Alberta
city: Edmonton
country: Canada
facility: Misericordia Community Hospital
state: Alberta
city: Edmonton
country: Canada
facility: Royal Alexandra Hospital
state: Alberta
city: Edmonton
country: Canada
facility: University of Alberta Hospital
state: Alberta
city: Edson
country: Canada
facility: Edson Healthcare Centre
state: Alberta
city: Elk Point
country: Canada
facility: Elk Point Healthcare Centre
state: Alberta
city: Fairview
country: Canada
facility: Fairview Health Complex
state: Alberta
city: Fort McMurray
country: Canada
facility: Northern Lights Regional Health Centre
state: Alberta
city: Fort Saskatchewan
country: Canada
facility: Fort Saskatchewan Community Hospital
state: Alberta
city: Fort Vermilion
country: Canada
facility: St. Theresa General Hospital
state: Alberta
city: Fox Creek
country: Canada
facility: Fox Creek Healthcare Centre
state: Alberta
city: Grande Cache
country: Canada
facility: Grande Cache Community Health Complex
state: Alberta
city: Grande Prairie
country: Canada
facility: Grande Prairie Regional Hospital
state: Alberta
city: Grimshaw
country: Canada
facility: Grimshaw / Berwyn and District Community Health Centre
state: Alberta
city: Hanna
country: Canada
facility: Hanna Health Centre
state: Alberta
city: Hardisty
country: Canada
facility: Hardisty Health Centre
state: Alberta
city: High Level
country: Canada
facility: Northwest Health Centre
state: Alberta
city: High Prairie
country: Canada
facility: High Prairie Health Complex
state: Alberta
city: High River
country: Canada
facility: High River General Hospital
state: Alberta
city: Hinton
country: Canada
facility: Hinton Healthcare Centre
state: Alberta
city: Innisfail
country: Canada
facility: Innisfail Health Centre
state: Alberta
city: Jasper
country: Canada
facility: Seton - Jasper Healthcare Centre
state: Alberta
city: Killam
country: Canada
facility: Killam Health Centre
state: Alberta
city: Lac La Biche
country: Canada
facility: William J Cadzow - Lac La Biche Health Care Centre
state: Alberta
city: Lacombe
country: Canada
facility: Lacombe Hospital
state: Alberta
city: Lamont
country: Canada
facility: Lamont Health Centre
state: Alberta
city: Leduc
country: Canada
facility: Leduc Community Hospital
state: Alberta
city: Lethbridge
country: Canada
facility: Chinook Regional Hospital
state: Alberta
city: Lloydminster
country: Canada
facility: Lloydminster Hospital
state: Alberta
city: Manning
country: Canada
facility: Manning Community Health Centre
state: Alberta
city: Mayerthorpe
country: Canada
facility: Mayerthorpe Healthcare Centre
state: Alberta
city: McLennan
country: Canada
facility: Sacred Heart Community Healt
state: Alberta
city: Medicine Hat
country: Canada
facility: Medicine Hat Regional Hospital
state: Alberta
city: Olds
country: Canada
facility: Olds Hospital and Care Centre
state: Alberta
city: Oyen
country: Canada
facility: Big Country Hospital
state: Alberta
city: Peace River
country: Canada
facility: Peace River Community Health Centre
state: Alberta
city: Pincher Creek
country: Canada
facility: Pincher Creek Health Centre
state: Alberta
city: Ponoka
country: Canada
facility: Ponoka Hospital
state: Alberta
city: Provost
country: Canada
facility: Provost Health Centre
state: Alberta
city: Raymond
country: Canada
facility: Raymond Health Centre
state: Alberta
city: Red Deer
country: Canada
facility: Red Deer Regional Hospital Centre
state: Alberta
city: Redwater
country: Canada
facility: Redwater Health Centre
state: Alberta
city: Rimbey
country: Canada
facility: Rimbey Hospital
state: Alberta
city: Rocky Mountain House
country: Canada
facility: Rocky Mountain House Health Centre
state: Alberta
city: Rockyview
country: Canada
facility: Rockyview General Hospital
state: Alberta
city: Slave Lake
country: Canada
facility: Slave Lake Healthcare Centre
state: Alberta
city: Smoky Lake
country: Canada
facility: George McDougall - Smoky Lake Healthcare Centre
state: Alberta
city: Spirit River
country: Canada
facility: Central Peace Health Complex
state: Alberta
city: St. Albert
country: Canada
facility: Sturgeon Community Hospital
state: Alberta
city: St. Paul
country: Canada
facility: St. Therese - St. Paul Healthcare Centre
state: Alberta
city: Stettler
country: Canada
facility: Stettler Hospital
state: Alberta
city: Strathmore
country: Canada
facility: Strathmore District Health Services
state: Alberta
city: Sundre
country: Canada
facility: Myron Thompson Health Centre
state: Alberta
city: Swan Hills
country: Canada
facility: Swan Hills Healthcare Centre
state: Alberta
city: Taber
country: Canada
facility: Taber Health Centre
state: Alberta
city: Three Hills
country: Canada
facility: Three Hills Health Centre
state: Alberta
city: Tofield
country: Canada
facility: Tofield Health Centre
state: Alberta
city: Two Hills
country: Canada
facility: Two Hills Health Centre
state: Alberta
city: Valleyview
country: Canada
facility: Valleyview Health Centre
state: Alberta
city: Vegreville
country: Canada
facility: St. Joseph's General Hospital
state: Alberta
city: Vermilion
country: Canada
facility: Vermilion Health Centre
state: Alberta
city: Viking
country: Canada
facility: Viking Health Centre
state: Alberta
city: Vulcan
country: Canada
facility: Vulcan Community Health Centre
state: Alberta
city: Wabasca
country: Canada
facility: Wabasca/Desmarais Healthcare Centre
state: Alberta
city: Wainwright
country: Canada
facility: Wainwright Health Centre
state: Alberta
city: Westlock
country: Canada
facility: Westlock Healthcare Centre
state: Alberta
city: Westview
country: Canada
facility: Westview Health Centre
state: Alberta
city: Wetaskiwin
country: Canada
facility: Wetaskiwin Hospital
state: Alberta
city: Whitecourt
country: Canada
facility: Whitecourt Healthcare Centre
state: Alberta
Study officials:
affiliation: University of Alberta
name: Justin Chen, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Remtulla S, Zurek K, Cervera C, Hernandez C, Lee MC, Hoang HL. Impact of an Unsolicited, Standardized Form-Based Antimicrobial Stewardship Intervention to Improve Guideline Adherence in the Management of Staphylococcus aureus Bacteremia. Open Forum Infect Dis. 2019 Feb 26;6(4):ofz098. doi: 10.1093/ofid/ofz098. eCollection 2019 Apr.