# Impact of an electronic antibiotic time-out best practice alert on antibiotic use and prescribing behavior in hospitalized patients

## TL;DR

This study evaluated an electronic antibiotic time-out alert to improve antibiotic use in hospitalized patients but found no significant improvement in optimizing prescriptions.

## Contribution

The study introduces an electronic antibiotic time-out alert system integrated into the medical record for stewardship.

## Key findings

- No significant difference in antibiotic optimization rates before and after implementation.
- A numerically lower rate of antibiotic escalation was observed post-implementation.
- Duration of antibiotic therapy increased after the alert implementation.

## Abstract

Provider-directed electronic antibiotic time-outs (ATOs) are a stewardship strategy capable of efficient and widespread impact with relatively low perceived personnel effort. This is a multi-center, quasi-experimental, retrospective chart review of patients admitted receiving empiric antibiotics for >72 hours. An ATO alert was designed and embedded within the electronic medical record and set to fire between the hours of 07:00 and 16:30 daily. Seventy-two hours after a unique antibiotic order was entered, a best practice alert (BPA) would fire for the primary team—including the attending physician, residents, and advanced practice providers—as well as any infectious disease provider consulted at the time of ATO firing. This alert is triggered when entering or modifying orders as an active pop-up to the ordering prescriber. Prescribers were then prompted to assess the patient for potential antibiotic optimization—including discontinuation, de-escalation, and transition to oral therapies. A total of 800 patients receiving >72 hours of antibiotics were included for analysis. There was no statistically significant difference in the rate of antibiotic optimization when comparing the pre- and post-implementation cohort (54.5% vs 57.5%, P = 0.433); however, there was a numerically lower rate of antibiotic escalation in the post-cohort (9.5% vs 5.8%, P = 0.062). Duration of antibiotic therapy was longer in the post-implementation cohort (4.7 vs 5.0 days, P < 0.001). The implementation of an ATO BPA failed to improve the rates of antibiotic optimization.