Affiliation:
1. Monroe Carell Jr. Children's Hospital at VUMC Vanderbilt University School of Medicine Nashville Tennessee USA
2. UPMC Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
3. UT Southwestern Medical Center Dallas Texas USA
4. Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
5. University of Utah and Primary Children's Hospital Salt Lake City Utah USA
Abstract
AbstractBackgroundElectronic health record‐based clinical decision support (CDS) is a promising antibiotic stewardship strategy. Few studies have evaluated the effectiveness of antibiotic CDS in the pediatric emergency department (ED).ObjectiveTo compare the effectiveness of antibiotic CDS vs. usual care for promoting guideline‐concordant antibiotic prescribing for pneumonia in the pediatric ED.DesignPragmatic randomized clinical trial.Setting and ParticipantsEncounters for children (6 months‐18 years) with pneumonia presenting to two tertiary care children s hospital EDs in the United States.InterventionCDS or usual care was randomly assigned during 4‐week periods within each site. The CDS intervention provided antibiotic recommendations tailored to each encounter and in accordance with national guidelines.Main Outcome and MeasuresThe primary outcome was exclusive guideline‐concordant antibiotic prescribing within the first 24 h of care. Safety outcomes included time to first antibiotic order, encounter length of stay, delayed intensive care, and 3‐ and 7‐day revisits.Results1027 encounters were included, encompassing 478 randomized to usual care and 549 to CDS. Exclusive guideline‐concordant prescribing did not differ at 24 h (CDS, 51.7% vs. usual care, 53.3%; odds ratio [OR] 0.94 [95% confidence interval [CI]: 0.73, 1.20]). In pre‐specified stratified analyses, CDS was associated with guideline‐concordant prescribing among encounters discharged from the ED (74.9% vs. 66.0%; OR 1.53 [95% CI: 1.01, 2.33]), but not among hospitalized encounters. Mean time to first antibiotic was shorter in the CDS group (3.0 vs 3.4 h; p = .024). There were no differences in safety outcomes.ConclusionsEffectiveness of ED‐based antibiotic CDS was greatest among those discharged from the ED. Longitudinal interventions designed to target both ED and inpatient clinicians and to address common implementation challenges may enhance the effectiveness of CDS as a stewardship tool.
Funder
National Center for Advancing Translational Sciences
National Institutes of Health
Subject
Assessment and Diagnosis,Care Planning,Health Policy,Fundamentals and skills,General Medicine,Leadership and Management
Cited by
2 articles.
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