Effect of an antibiotic checklist on length of hospital stay and appropriate antibiotic use in adult patients treated with intravenous antibiotics: a stepped wedge cluster randomized trial

Quality indicators (QIs) have been developed to define appropriate antibiotic use in hospitalized patients. We evaluated whether a checklist based on these QIs affects appropriate antibiotic use and length of hospital stay. An antibiotic checklist for patients treated with intravenous antibiotics wa...

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Bibliographic Details
Published in:	Clinical microbiology and infection Vol. 23; no. 7; pp. 485.e1 - 485.e8
Main Authors:	van Daalen, F.V., Prins, J.M., Opmeer, B.C., Boermeester, M.A., Visser, C.E., van Hest, R.M., Branger, J., Mattsson, E., van de Broek, M.F.M., Roeleveld, T.C., Karimbeg, A.A., Haak, E.A.F., van den Hout, H.C., van Agtmael, M.A., Hulscher, M.E.J.L., Geerlings, S.E.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-07-2017
Subjects:	Administration, Intravenous Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Antibiotic checklist Antibiotic stewardship Appropriate antibiotic use Cluster randomized trial Drug Utilization Female Humans Length of Stay Male Middle Aged Netherlands Quality improvement Quality indicators Young Adult Quality indicators Appropriate antibiotic use Quality improvement Antibiotic stewardship Antibiotic checklist Cluster randomized trial
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Summary:	Quality indicators (QIs) have been developed to define appropriate antibiotic use in hospitalized patients. We evaluated whether a checklist based on these QIs affects appropriate antibiotic use and length of hospital stay. An antibiotic checklist for patients treated with intravenous antibiotics was introduced in nine Dutch hospitals in a stepped wedge cluster randomized trial. Prophylaxis was excluded. We included a random sample before (baseline), and all eligible patients after (intervention) checklist introduction. Baseline and intervention outcomes were compared. Primary endpoint was length of stay (LOS), analysed by intention to treat. Secondary endpoints, including QI performances, QI sum score (performance on all QIs per patient), and quality of checklist use, were analysed per protocol. Between 1 November 2014 and 1 October 2015 we included 853 baseline and 5354 intervention patients, of whom 993 (19%) had a completed checklist. The LOS did not change (baseline geometric mean 10.0 days (95% CI 8.6–11.5) versus intervention 10.1 days (95% CI 8.9–11.5), p 0.8). QI performances increased between +3.0% and +23.9% per QI, and the percentage of patients with a QI sum score above 50% increased significantly (OR 2.4 (95% CI 2.0–3.0), p<0.001). Higher QI sum scores were significantly associated with shorter LOS. Discordance existed between checklist-answers and actual performance. Use of an antibiotic checklist resulted in a significant increase in appropriateness of antibiotic use, but not in a reduction of LOS. Low overall checklist completion rates and discordance between checklist-answers and actual provided care might have attenuated the impact of the checklist.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23
ISSN:	1198-743X 1469-0691
DOI:	10.1016/j.cmi.2017.01.019