Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds

Matthew D.M. Rawlins, Edward Raby, Frank M. Sanfilippo, Rae Douglass, Jonathan Chambers, Duncan McLellan, John R. Dyer

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds).

Design: Retrospective, single-centre observational study between March 2015 and February 2016.

Setting: A new quaternary referral centre.

Study Participants: Adults referred for antimicrobial rounds outside of the intensive care and haematology units.

Intervention: Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system.

Main Outcome Measures: The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam.

Results: Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased.

Conclusions: The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.

Original languageEnglish
Pages (from-to)637-641
Number of pages5
JournalInternational journal for quality in health care : journal of the International Society for Quality in Health Care
Volume30
Issue number8
DOIs
Publication statusPublished - 1 Oct 2018

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Referral and Consultation
Glycopeptides
Fluoroquinolones
Carbapenems
Hematology
Cephalosporins
Pharmacists
Observational Studies
Intensive Care Units
Outcome Assessment (Health Care)
Anti-Bacterial Agents
Health

Cite this

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title = "Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds",
abstract = "Objective: To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds).Design: Retrospective, single-centre observational study between March 2015 and February 2016.Setting: A new quaternary referral centre.Study Participants: Adults referred for antimicrobial rounds outside of the intensive care and haematology units.Intervention: Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system.Main Outcome Measures: The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam.Results: Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59{\%} to 88{\%} (P < 0.001); 75.7{\%} of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18{\%} to 8.5{\%} (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased.Conclusions: The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.",
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Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds. / Rawlins, Matthew D.M.; Raby, Edward; Sanfilippo, Frank M.; Douglass, Rae; Chambers, Jonathan; McLellan, Duncan; Dyer, John R.

In: International journal for quality in health care : journal of the International Society for Quality in Health Care, Vol. 30, No. 8, 01.10.2018, p. 637-641.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds

AU - Rawlins, Matthew D.M.

AU - Raby, Edward

AU - Sanfilippo, Frank M.

AU - Douglass, Rae

AU - Chambers, Jonathan

AU - McLellan, Duncan

AU - Dyer, John R.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Objective: To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds).Design: Retrospective, single-centre observational study between March 2015 and February 2016.Setting: A new quaternary referral centre.Study Participants: Adults referred for antimicrobial rounds outside of the intensive care and haematology units.Intervention: Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system.Main Outcome Measures: The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam.Results: Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased.Conclusions: The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.

AB - Objective: To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds).Design: Retrospective, single-centre observational study between March 2015 and February 2016.Setting: A new quaternary referral centre.Study Participants: Adults referred for antimicrobial rounds outside of the intensive care and haematology units.Intervention: Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system.Main Outcome Measures: The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam.Results: Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased.Conclusions: The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.

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U2 - 10.1093/intqhc/mzy088

DO - 10.1093/intqhc/mzy088

M3 - Article

VL - 30

SP - 637

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JO - International Journal for Quality in Health Care

JF - International Journal for Quality in Health Care

SN - 1353-4505

IS - 8

ER -