May 28, 2019
2 min read

EHR-based 72-hour time-out reduces antibiotic therapy duration

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An electronic health record-based antimicrobial time-out that prompted prescribers after 72 hours “to review antimicrobials with an empiric indication and no defined duration” resulted in the discontinuation or de-escalation of 21% of empiric antimicrobials at a large health system within 6 hours after the antibiotic time-out alert, researchers reported.

They found that the time-out led to a significant reduction in the duration of antimicrobial therapy, but no impact on overall antimicrobial usage, according to findings published in Infection Control & Hospital Epidemiology.

Antimicrobial time-outs (ATOs) should be used as a broad intervention to facilitate a review of antibiotic therapies, typically at 48 to 72 hours, as suggested by the CDC Core Elements of Hospital Antibiotic Stewardship Program, according to Steven R. Richardson, PharmD, clinical pharmacist at Kaweah Delta Medical Center in Visalia, California, and colleagues. However, limited data are available regarding the impact of ATOs on antimicrobial consumption, appropriateness and clinical outcomes, the study highlighted.

Richardson and colleagues conducted a retrospective quasi-experimental study that included inpatients from either an academic medical center or one of eight health-system community hospitals who received one or more systemic antimicrobials from October to December 2016 — before the ATO was implemented — and from October to December of 2017 — after the ATO was implemented.

“The primary objective was to compare antimicrobial days of therapy per 1,000 patient days (DOT per 1,000 PD) before and after ATO implementation,” Richardson and colleagues wrote.

Of the 31,945 patients in the preintervention group, 16% had an active empiric antimicrobial at 72 hours and “would have been eligible for an ATO,” according to the study. Comparatively, 18% of the 33,378 patients in the postintervention group had an ATO alert at 72 hours.

The researchers reported that 44.2% of alerts were acknowledged by residents and fellows, 33.7% by staff physicians and 22.1% by nurse practitioners. After ATO acknowledgement, 17.2% of antimicrobials were discontinued and 3.8% were de-escalated. There was not a significant difference in DOT per 1,000 PD before and after ATO implementation (P = .5).

Richardson and colleagues noted that the median duration of empiric antimicrobials was reduced from 71 hours to 62 hours among ATO-eligible patients in the postintervention group (P < .05).

“Given the increasing regulatory emphasis on ATOs as a stewardship intervention combined with a paucity of data, it is notable that in our study, a prescriber-facing, electronic ATO did not demonstrate a significant effect on overall antimicrobial DOT per 1,000 PD,” the researchers wrote. “Further studies are needed to identify ideal ATO characteristics and outcome metrics reflecting the impact of ATOs as a stewardship tool.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.