N/A N=4 Health Services Research

Improving Antimicrobial-Prescribing in Emergency Departments

Anti-Bacterial Agents · Respiratory Tract Infections

Bottom Line

View on ClinicalTrials.gov: NCT03349567 ↗

Enrolled (actual)

Serious AEs

6.5%

Results posted

Apr 2021

Primary outcome: Primary: 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

Study Design & Population

Study type: Interventional
Phase: N/A
Interventions: Audit-and-feedback (Behavioral)
Age: Pediatric, Adult, Older Adult
Sex: All
Sponsor: Iowa City Veterans Affairs Medical Center
Primary completion: Sep 2019

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

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.

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.

View full record on ClinicalTrials.gov →

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.