Antibiotic Time-Outs and Duration of Therapy
The CDC and TJC recommend the use of interventions such as antibiotic time outs (ATOs) or prospective audit and feedback (PAF) to improve antibiotic prescribing. ATOs may occur as part of standard practice without ASP involvement, prompting providers to have a structured conversation regarding appropriateness of antibiotic regimens and durations.
Thom and colleagues performed a quasi-experimental study pre- and post- implementation of an ATO across 11 units (including adult and pediatric general and intensive care wards) located in 6 different hospitals in Maryland to measure the impact of a provider- driven ATO. Pre-intervention data were collected during a 6-month baseline period and post- intervention data were collected for 9 months following implementation of the paper ATO tool that prompted care teams on antibiotic days 3-5 without input from the study or stewardship team. Primary outcomes were hospital antibiotic DOT per patient admission and total antibiotic DOT per patient admission, including antibiotic prescriptions at discharge. Secondary outcomes included proportion of cases in which there was a modification or discontinuation of the regimen within 3-5 calendar days of onset as well as antibiotic appropriateness. There was no difference between hospital DOT per admission or total DOT per admission in the pre- versus post- implementation groups, prior to and after controlling for unit and seasonal differences. Multivariable analysis showed no association between ATO intervention and number of times antibiotic regimens were modified or discontinued on days 3-5.
The findings of this study contribute to growing evidence supporting the impact of ASP input on improving antimicrobial utilization and overall patient outcomes. Further studies are needed to investigate the impact of additional adjunctive methods with ASP feedback on antibiotic use.
Clinical Infectious Diseases, Volume 68, Issue 9, 1 May 2019, Pages 1581–1584
A multicenter quasi-experimental study of a provider-driven antibiotic “time-out” in 3470 antibiotic courses showed no difference in antibiotic use before and after implementation, but did show a decrease in inappropriate therapy (45% vs 31%, P < .05). Single time-outs without input from antibiotic stewardship teams are insufficient to optimize prescribing.
A provider-driven ATO on antibiotic days 3–5 (up to 5 days postprescription allowed for review postweekend or holiday that may have otherwise been missed) was prompted by the care team on each unit during rounds without direction from research or stewardship teams. Care teams completed a paper ATO tool that included current antibiotics, indication, clinical assessment, and plan for change (Supplementary Materials). Individual patients were eligible for the intervention more than once during a hospital stay (or across multiple hospitalizations) if the trigger antibiotics were prescribed for a new indication. The ATO was not triggered based on a change in antibiotic dose or route of administration.