N/A
Completed N=4
Improving Antimicrobial-Prescribing in Emergency Departments
Anti-Bacterial Agents · Respiratory Tract Infections
Source: ClinicalTrials.gov NCT03349567 ↗
Enrolled (actual)
4
Serious AEs
6.5%
Results posted
Apr 2021
Primary outcomePrimary: Percentage of Patient-visits Prescribed an Antimicrobial at Their ED Visit — 21.2; 20.9; 19.1; 21.6 percentage of visits prescribed an abx — p=0.35
Summary
Antimicrobial resistance is one of today's most urgent public health problems. One of the most important strategies to slow the spread of antimicrobial resistance is the promotion of judicious antimicrobial use. There are tremendous opportunities to reduce unnecessary antimicrobial-prescribing, particularly in Emergency Departments (EDs). In this study, the investigators will work collaboratively with ED providers in the Veterans Health Administration (VHA) to reduce unnecessary antimicrobial use. Academic-detailing and an audit-and-feedback intervention will be implemented, and the study will assess how overall antimicrobial-prescribing changes once these interventions are performed. ED providers will be shown how their antimicrobial-prescribing compares to their peers, thereby encouraging them to consider their professional reputation when making prescribing decisions. To assess the impact of this intervention, the study will monitor providers' antimicrobial-prescribing behavior through an automated metric, i.e. number of antimicrobial prescriptions per number of patient-visits. To assess changes in the appropriateness of antimicrobial-prescribing, the study team will also perform manual chart reviews and compare prescribing decisions to published guidelines.
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Percentage of Patient-visits Prescribed an Antimicrobial at Their ED Visit |
21.2; 20.9; 19.1; 21.6 | 0.35 |
| SECONDARY Percentage of Patient-visits Prescribed a Late Antimicrobial Prescription More Than 24 Hours After But Within 30 Days of Their ED Visit |
31.5; 29.5; 31.1; 28.5 | — |
| SECONDARY Percentage of Patient-visits Who Were Hospitalized More Than 24 Hours After But Within 30 Days of Their ED Visit |
5.9; 5.6; 5.9; 5.8 | — |
| SECONDARY Percentage of Patient-visits Who Died More Than 24 Hours After But Within 30 Days of Their ED Visit |
0.56; 0.61; 0.60; 0.59 | — |
| SECONDARY Percentage of Patient-visits Who Underwent Clostridium Difficile Testing More Than 24 Hours After But Within 30 Days of Their ED Visit |
0.60; 0.86; 0.69; 0.89 | — |
| SECONDARY Percentage of Patient-visits Who Received Guideline Concordant Antimicrobial Management |
125; 123; 166; 131 | 0.001 sig |
| SECONDARY Percentage of Patient-visits Prescribed an Antibiotic at Their ED Visit |
20.8; 20.6; 18.2; 20.6 | 0.46 |
Eligibility Criteria
Inclusion Criteria
--An ED provider at one of the intervention or control sites.
Exclusion Criteria
--An ED provider who sees less than 100 patients in the ED per year.
Data sourced from ClinicalTrials.gov (NCT03349567). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.