Format

Send to

Choose Destination
Clin Microbiol Infect. 2017 Jul;23(7):485.e1-485.e8. doi: 10.1016/j.cmi.2017.01.019. Epub 2017 Jan 31.

Effect of an antibiotic checklist on length of hospital stay and appropriate antibiotic use in adult patients treated with intravenous antibiotics: a stepped wedge cluster randomized trial.

Author information

1
Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, The Netherlands. Electronic address: f.v.vandaalen@amc.nl.
2
Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, The Netherlands.
3
Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands.
4
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
5
Department of Microbiology, Academic Medical Centre, Amsterdam, The Netherlands.
6
Department of Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands.
7
Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands.
8
Department of Medical Microbiology, Reinier de Graaf, Delft, The Netherlands.
9
Department of Internal Medicine, Antoniusziekenhuis, Nieuwegein, The Netherlands.
10
Department of Internal Medicine, Spaarnegasthuis, Hoofddorp, The Netherlands.
11
Department of Internal Medicine, Westfriesgasthuis, Hoorn, The Netherlands.
12
Department of Hospital Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
13
Department of Internal Medicine, Spaarnegasthuis, Haarlem, The Netherlands.
14
Department of Internal Medicine, Division of Infectious Diseases, VU Medical Centre, Amsterdam, The Netherlands.
15
Department of Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.

Abstract

OBJECTIVES:

Quality indicators (QIs) have been developed to define appropriate antibiotic use in hospitalized patients. We evaluated whether a checklist based on these QIs affects appropriate antibiotic use and length of hospital stay.

METHODS:

An antibiotic checklist for patients treated with intravenous antibiotics was introduced in nine Dutch hospitals in a stepped wedge cluster randomized trial. Prophylaxis was excluded. We included a random sample before (baseline), and all eligible patients after (intervention) checklist introduction. Baseline and intervention outcomes were compared. Primary endpoint was length of stay (LOS), analysed by intention to treat. Secondary endpoints, including QI performances, QI sum score (performance on all QIs per patient), and quality of checklist use, were analysed per protocol.

RESULTS:

Between 1 November 2014 and 1 October 2015 we included 853 baseline and 5354 intervention patients, of whom 993 (19%) had a completed checklist. The LOS did not change (baseline geometric mean 10.0 days (95% CI 8.6-11.5) versus intervention 10.1 days (95% CI 8.9-11.5), p 0.8). QI performances increased between +3.0% and +23.9% per QI, and the percentage of patients with a QI sum score above 50% increased significantly (OR 2.4 (95% CI 2.0-3.0), p<0.001). Higher QI sum scores were significantly associated with shorter LOS. Discordance existed between checklist-answers and actual performance.

CONCLUSIONS:

Use of an antibiotic checklist resulted in a significant increase in appropriateness of antibiotic use, but not in a reduction of LOS. Low overall checklist completion rates and discordance between checklist-answers and actual provided care might have attenuated the impact of the checklist.

KEYWORDS:

Antibiotic checklist; Antibiotic stewardship; Appropriate antibiotic use; Cluster randomized trial; Quality improvement; Quality indicators

PMID:
28159671
DOI:
10.1016/j.cmi.2017.01.019
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center