Quasi-experimental Study Comparing Intravenous Antibiotics Prescriptions at Hospital Discharge With and Without ID Consultation
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Chiang Mai University
- Enrollment
- 173
- Locations
- 1
- Primary Endpoint
- The proportion of appropriateness of intravenous antibiotics prescriptions at hospital discharge between groups
Study Overview
Brief Summary
A quasi-experimental study was conducted among patients receiving care at the medicine units of the Maharaj Nakorn Chiang Mai Hospital to determine the appropriateness of intravenous antibiotics at hospital discharge with and without ID consultation.
Detailed Description
The pre-intervention period was started from November 1, 2015 to April 30, 2016 (6-month period), in which the intravenous antibiotics at hospital discharge were prescribed by the primary care team. The post-intervention period was started from May 1, 2016 to February 28, 2017 (10-month period), in which the intravenous antibiotics at hospital discharge were reviewed and intervened by ID team.
The appropriateness of intravenous antibiotics was assessed separately by the ID fellow and ID specialist. If disagreement occurred, the feedback to the ID fellow was performed and the decision by ID specialist was used in the final analysis of appropriateness.
In post-intervention period, ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics
Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Sequential
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 15 Years to — (Child, Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •All adult patients who met the following criteria were consecutively enrolled;
- •age≥ 15 years old and
- •had infections at any sites and received intravenous antibiotics.
Exclusion Criteria
- •They were evaluated by infectious diseases specialist for appropriate antibiotics during admission
Arms & Interventions
pre-intervention period
The charts of patients who were prescribed intravenous antibiotics at hospital discharge were reviewed. Appropriateness of intravenous antibiotics was assessed by ID specialists.
post-intervention period
The intervention is the charts of patients who were prescribed intravenous antibiotics at hospital discharge by the primary team were prospectively reviewed and intervened by ID team (ID specialist approval)
Intervention: ID specialist approval (Procedure)
Outcomes
Primary Outcomes
The proportion of appropriateness of intravenous antibiotics prescriptions at hospital discharge between groups
Time Frame: 16 months
To calculate the number of antibiotic prescriptions at hospital discharge over the total number of prescriptions, comparing between pre-and post-intervention period.
Secondary Outcomes
- The costs of antibiotics for the course of treatment(16 months)
- Readmission within 30 days, length of hospital stay(30 days)
- Length of hospital stay(60 days)
- Clinical improvement at 1 week(1 week)
Investigators
Romanee Chaiwarith
Associate Professor
Chiang Mai University