Optimizing the Management of Staphylococcus Aureus Bacteremia (OPTIMUS-SAB)
- Conditions
- Staph Aureus Bacteremia
- Interventions
- Other: OPTIMUS-SAB clinical care pathway
- Registration Number
- NCT06338176
- Lead Sponsor
- University of Alberta
- Brief Summary
Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality rates with an incidence disproportionately higher in vulnerable populations. Management according to evidence-based care parameters, in particular Infectious Diseases (ID) consultation, is associated with improved mortality. SAB management is suboptimal in Alberta compared to other jurisdictions. An Alberta-based pilot study confirmed that timely recommendations to optimize SAB care, including ID consultation, was associated with improved adherence to all evidence-based quality-of-care indicators.
Leveraging this pilot work, the investigators aim to implement OPTIMUS-SAB, an enhanced model of the pilot, to optimize and standardize SAB management across Alberta. The implementation study will be a zone-based acute care site stepped wedge design. OPTIMUS-SAB will consist of a centralized SAB care team whom will receive automated notification of all blood cultures positive for S. aureus allowing them to review the patient's medical chart and make preliminary management recommendations according to an evidence-based care bundle.
The investigators will evaluate adherence to evidence-based SAB quality-of-care indicators before and after OPTIMUS-SAB implementation and expect this to improve with a resultant reduction in duration of bacteremia, length of stay, readmission rates, and mortality. In turn, this will translate into cost savings for the health care system.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 1800
- Age greater than 18 years at the time of hospital admission
- Confirmed S. aureus bacteremia by blood culture performed at a laboratory in Alberta, Canada
- Admitted to a designated acute care site in Alberta, Canada
- The treating team believes death is imminent or inevitable .
- GCD are C-level within 48 hours of admission.
- The patient is transferred in from an out-of-province acute care center with a pre-existing SAB diagnosis.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description OPTIMUS-SAB care pathway OPTIMUS-SAB clinical care pathway Province-wide real time automated notifications of new SAB cases will be established and delivered to a centralized SAB care team electronically through Connect Care. The centralized SAB care team consists of a SAB clinical coordinator, ID specialists and other ad hoc representation depending on patient needs. Following patient chart review, the centralized SAB care team contacts the most responsible physician (MRP) to provide preliminary recommendations to optimize care, both verbally and in written format, facilitated by Connect Care (Alberta Health Services electronic medical record).
- Primary Outcome Measures
Name Time Method Adherence to quality-of-care indicators Within 90 days Defined as:
1. ID involvement and time to ID involvement, defined by the presence of an ID consult note and/or recommendations in the chart.
2. Repeat blood cultures, to document clearance of bacteremia, within 72 hours from the last positive blood culture.
3. Guideline-concordant empiric antibiotic administered and time to receipt.
4. Guideline concordant definitive antibiotic administered and time to receipt.
5. Therapeutic drug monitoring of patents treatments with vancomycin.
6. Appropriate dose adjustment of antimicrobials based on renal function according to local guidelines.
7. Echocardiogram (transthoracic or transesophageal) performed within 72 hours of diagnosis.
8. Source control achieved.
9. Appropriate duration of antibiotic therapy ordered and delivered.
- Secondary Outcome Measures
Name Time Method In hospital mortality 90 days death within hospital stay
Costing evaluation One year Cost of SAB treatment related to hospitalization, including physician provision of care, and antibiotics.
Implementation evaluation 3 years User experience and feedback from patients and providers will be collected at the start and end of each active implementation phase. This information will be paired with assessments of barriers, facilitators, and contextual factors informed by the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory during the pre-implementation phase and at the end of active implementation.
Hospital re-admission rates 90 days re-admission to acute care rate
All-cause mortality 180 days death from any cause
Length of stay 180 days maximum Acute hospital length of stay
Trial Locations
- Locations (101)
Arthur J.E. Child Comprehensive Cancer Centre
🇨🇦Calgary, Alberta, Canada
Oilfields General Hospital
🇨🇦Black Diamond, Alberta, Canada
Claresholm General Hospital
🇨🇦Claresholm, Alberta, Canada
Tom Baker Cancer Centre
🇨🇦Calgary, Alberta, Canada
Barrhead Healthcare Centre
🇨🇦Barrhead, Alberta, Canada
Coaldale Health Centre
🇨🇦Coaldale, Alberta, Canada
Boyle Healthcare Centre
🇨🇦Boyle, Alberta, Canada
Our Lady of the Rosary Hospital
🇨🇦Castor, Alberta, Canada
Crowsnest Pass Health Centre
🇨🇦Crowsnest Pass, Alberta, Canada
Seton - Jasper Healthcare Centre
🇨🇦Jasper, Alberta, Canada
Chinook Regional Hospital
🇨🇦Lethbridge, Alberta, Canada
Athabasca Healthcare Centre
🇨🇦Athabasca, Alberta, Canada
Grande Cache Community Health Complex
🇨🇦Grande Cache, Alberta, Canada
Fairview Health Complex
🇨🇦Fairview, Alberta, Canada
High Prairie Health Complex
🇨🇦High Prairie, Alberta, Canada
Mayerthorpe Healthcare Centre
🇨🇦Mayerthorpe, Alberta, Canada
Brooks Health Centre
🇨🇦Brooks, Alberta, Canada
Foothills Medical Centre
🇨🇦Calgary, Alberta, Canada
South Health Campus
🇨🇦Calgary, Alberta, Canada
Bassano Health Centre
🇨🇦Bassano, Alberta, Canada
Peter Lougheed Centre
🇨🇦Calgary, Alberta, Canada
Mineral Springs Hospital
🇨🇦Banff, Alberta, Canada
Consort Hospital and Care Centre
🇨🇦Consort, Alberta, Canada
Daysland Health Centre
🇨🇦Daysland, Alberta, Canada
Northern Lights Regional Health Centre
🇨🇦Fort McMurray, Alberta, Canada
Peace River Community Health Centre
🇨🇦Peace River, Alberta, Canada
Pincher Creek Health Centre
🇨🇦Pincher Creek, Alberta, Canada
Slave Lake Healthcare Centre
🇨🇦Slave Lake, Alberta, Canada
Tofield Health Centre
🇨🇦Tofield, Alberta, Canada
Wetaskiwin Hospital
🇨🇦Wetaskiwin, Alberta, Canada
Swan Hills Healthcare Centre
🇨🇦Swan Hills, Alberta, Canada
Three Hills Health Centre
🇨🇦Three Hills, Alberta, Canada
Coronation Hospital and Care Centre
🇨🇦Coronation, Alberta, Canada
St. Theresa General Hospital
🇨🇦Fort Vermilion, Alberta, Canada
Grey Nuns Community Hospital
🇨🇦Edmonton, Alberta, Canada
Fort Saskatchewan Community Hospital
🇨🇦Fort Saskatchewan, Alberta, Canada
Devon General Hospital
🇨🇦Devon, Alberta, Canada
Edson Healthcare Centre
🇨🇦Edson, Alberta, Canada
Drayton Valley Hospital and Care Centre
🇨🇦Drayton Valley, Alberta, Canada
Fox Creek Healthcare Centre
🇨🇦Fox Creek, Alberta, Canada
High River General Hospital
🇨🇦High River, Alberta, Canada
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Drumheller Health Centre
🇨🇦Drumheller, Alberta, Canada
Glenrose Rehabilitation Hospital
🇨🇦Edmonton, Alberta, Canada
Hanna Health Centre
🇨🇦Hanna, Alberta, Canada
Misericordia Community Hospital
🇨🇦Edmonton, Alberta, Canada
University of Alberta Hospital
🇨🇦Edmonton, Alberta, Canada
Elk Point Healthcare Centre
🇨🇦Elk Point, Alberta, Canada
Grande Prairie Regional Hospital
🇨🇦Grande Prairie, Alberta, Canada
Hinton Healthcare Centre
🇨🇦Hinton, Alberta, Canada
Killam Health Centre
🇨🇦Killam, Alberta, Canada
Hardisty Health Centre
🇨🇦Hardisty, Alberta, Canada
Innisfail Health Centre
🇨🇦Innisfail, Alberta, Canada
Northwest Health Centre
🇨🇦High Level, Alberta, Canada
Big Country Hospital
🇨🇦Oyen, Alberta, Canada
Rockyview General Hospital
🇨🇦Rockyview, Alberta, Canada
Medicine Hat Regional Hospital
🇨🇦Medicine Hat, Alberta, Canada
Valleyview Health Centre
🇨🇦Valleyview, Alberta, Canada
Lamont Health Centre
🇨🇦Lamont, Alberta, Canada
Rimbey Hospital
🇨🇦Rimbey, Alberta, Canada
Central Peace Health Complex
🇨🇦Spirit River, Alberta, Canada
Stettler Hospital
🇨🇦Stettler, Alberta, Canada
Sacred Heart Community Healt
🇨🇦McLennan, Alberta, Canada
Redwater Health Centre
🇨🇦Redwater, Alberta, Canada
Olds Hospital and Care Centre
🇨🇦Olds, Alberta, Canada
Two Hills Health Centre
🇨🇦Two Hills, Alberta, Canada
Red Deer Regional Hospital Centre
🇨🇦Red Deer, Alberta, Canada
Rocky Mountain House Health Centre
🇨🇦Rocky Mountain House, Alberta, Canada
Wabasca/Desmarais Healthcare Centre
🇨🇦Wabasca, Alberta, Canada
Ponoka Hospital
🇨🇦Ponoka, Alberta, Canada
Viking Health Centre
🇨🇦Viking, Alberta, Canada
Myron Thompson Health Centre
🇨🇦Sundre, Alberta, Canada
Vermilion Health Centre
🇨🇦Vermilion, Alberta, Canada
St. Therese - St. Paul Healthcare Centre
🇨🇦St. Paul, Alberta, Canada
Taber Health Centre
🇨🇦Taber, Alberta, Canada
Strathmore District Health Services
🇨🇦Strathmore, Alberta, Canada
St. Joseph's General Hospital
🇨🇦Vegreville, Alberta, Canada
Wainwright Health Centre
🇨🇦Wainwright, Alberta, Canada
Westlock Healthcare Centre
🇨🇦Westlock, Alberta, Canada
Cold Lake Healthcare Centre
🇨🇦Cold Lake, Alberta, Canada
Didsbury District Health Services
🇨🇦Didsbury, Alberta, Canada
William J Cadzow - Lac La Biche Health Care Centre
🇨🇦Lac La Biche, Alberta, Canada
Lloydminster Hospital
🇨🇦Lloydminster, Alberta, Canada
Raymond Health Centre
🇨🇦Raymond, Alberta, Canada
George McDougall - Smoky Lake Healthcare Centre
🇨🇦Smoky Lake, Alberta, Canada
Sturgeon Community Hospital
🇨🇦St. Albert, Alberta, Canada
Westview Health Centre
🇨🇦Westview, Alberta, Canada
St. Mary's Hospital
🇨🇦Camrose, Alberta, Canada
Royal Alexandra Hospital
🇨🇦Edmonton, Alberta, Canada
Beaverlodge Municipal Hospital
🇨🇦Beaverlodge, Alberta, Canada
Bonnyville Healthcare Centre
🇨🇦Bonnyville, Alberta, Canada
Bow Island Health Centre
🇨🇦Bow Island, Alberta, Canada
Canmore General Hospital
🇨🇦Canmore, Alberta, Canada
Cardston Health Centre
🇨🇦Cardston, Alberta, Canada
Grimshaw / Berwyn and District Community Health Centre
🇨🇦Grimshaw, Alberta, Canada
Lacombe Hospital
🇨🇦Lacombe, Alberta, Canada
Leduc Community Hospital
🇨🇦Leduc, Alberta, Canada
Vulcan Community Health Centre
🇨🇦Vulcan, Alberta, Canada
Whitecourt Healthcare Centre
🇨🇦Whitecourt, Alberta, Canada
Manning Community Health Centre
🇨🇦Manning, Alberta, Canada
Provost Health Centre
🇨🇦Provost, Alberta, Canada