Dataset Information

Use of clinical decision support for antibiotic stewardship in the emergency department and outpatient clinics: An interrupted time-series analysis.

ABSTRACT:

Objective

To evaluate the impact of implementing clinical decision support (CDS) tools for outpatient antibiotic prescribing in the emergency department (ED) and clinic settings.

Design

We performed a before-and-after, quasi-experimental study that employed an interrupted time-series analysis.

Setting

The study institution was a quaternary, academic referral center in Northern California.

Participants

We included prescriptions for patients in the ED and 21 primary-care clinics within the same health system.

Intervention

We implemented a CDS tool for azithromycin on March 1, 2020, and a CDS tool for fluoroquinolones (FQs; ie, ciprofloxacin, levofloxacin, and moxifloxacin) on November 1, 2020. The CDS added friction to inappropriate ordering workflows while adding health information technology (HIT) features to easily perform recommended actions. The primary outcome was the number of monthly prescriptions for each antibiotic type, by implementation period (before vs after).

Results

Immediately after azithromycin-CDS implementation, monthly rates of azithromycin prescribing decreased significantly in both the ED (-24%; 95% CI, -37% to -10%; P < .001) and outpatient clinics (-47%; 95% CI, -56% to -37%; P < .001). In the first month after FQ-CDS implementation in the clinics, there was no significant drop in ciprofloxacin prescriptions; however, there was a significant decrease in ciprofloxacin prescriptions over time (-5% per month; 95% CI, -6% to -3%; P < .001), suggesting a delayed effect of the CDS.

Conclusion

Implementing CDS tools was associated with an immediate decrease in azithromycin prescriptions, in both the ED and clinics. CDS may serve as a valuable adjunct to existing antimicrobial stewardship programs.

SUBMITTER: Ford JS

PROVIDER: S-EPMC10186615 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Use of clinical decision support for antibiotic stewardship in the emergency department and outpatient clinics: An interrupted time-series analysis.

Ford James S JS Morgan Bustamante Brittany L BL Virk Mehr Kaur MK Ramirez Nancy N Matsumoto Cynthia G CG Lee Daniel Jin DJ MacDonald Scott S May Larissa L

Antimicrobial stewardship & healthcare epidemiology : ASHE 20230426 1

<h4>Objective</h4>To evaluate the impact of implementing clinical decision support (CDS) tools for outpatient antibiotic prescribing in the emergency department (ED) and clinic settings.<h4>Design</h4>We performed a before-and-after, quasi-experimental study that employed an interrupted time-series analysis.<h4>Setting</h4>The study institution was a quaternary, academic referral center in Northern California.<h4>Participants</h4>We included prescriptions for patients in the ED and 21 primary-ca ...[more]

PMID: 37205319

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Dataset Information

Use of clinical decision support for antibiotic stewardship in the emergency department and outpatient clinics: An interrupted time-series analysis.

Objective

Design

Setting

Participants

Intervention

Results

Conclusion

Publications

Use of clinical decision support for antibiotic stewardship in the emergency department and outpatient clinics: An interrupted time-series analysis.

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