Improving Initial Emergency Department Antibiotic Regimen Appropriateness for Patients Admitted to the Hospital with Pneumonia Using an Electronic Clinical Decision Support Tool

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James Pelegano, Jefferson School of Population Health, Thomas Jefferson University


Distinguished MS Capstone Project 2015

Pneumonia (PNA) is defined as a pulmonary infection. PNA ideal antibiotic regimen (IAbxR) selection from the Emergency Department (ED) has been directly correlated to improved outcomes, reduced hospital length of stay, costs and secondary infections. The Christiana Care Health System Antibiotic Stewardship Program (CCHS-ASP) provides recommendations on initial ideal antibiotic regimen (IAbxR). Prior ED provider compliance with IAbxR is 55%. A key barrier to optimal performance of IAbxR selection is the vast potential for selection of multiple antibiotics through our EMR/CPOE, knowledge gaps by providers as to the IAbxR. Culture change using change management principles and tools including engagement of key stakeholders, data gathering, PDSA, and rapid cycle testing were employed for this quality project. The project team successfully addressed organizational behaviors, project barriers and organizational goals, culminating in the development and integration of an electronic ED PNA clinical decision support rule (ED-PNA-CDS) for IAbxR selection. Our primary outcome was the rate of IAbxR compliance with CCHS-ASP guidelines for adult patients admitted to the hospital through the ED for PNA. Results: The ED-PNA-CDS was launched for all ED providers at all ED locations on February 17, 2015. To date a total of 699 CDS activations have occurred with 183 activations for PNA. The ED-PNA-CDS opt out rate was 8.2% (15/183). Users completed the PNA specific CDS tool 91.8% of the time and 99.7% for all ED-PNA-CDS activations. The post project rate of IAbxR compliance is 90% (p = 0.002). In conclusion, our project, the development and integration of an electronic ED-PNA-CDS resulted in significant culture change by increasing IAbxR compliance from 55% to 90% for adult ED patients admitted with PNA. Other potential benefits may include improved clinical patient outcomes, broader institutional antibiotic stewardship, and improved financial performance for CCHS through the reduction in costs.

Presentation: 39 minutes

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