P-960. Evaluation of a discharge-focused stewardship intervention in a stepped wedge cluster randomized trial across 10 hospitals

TL;DR

A hospital discharge antibiotic stewardship program was tested across 10 hospitals but did not significantly reduce antibiotic use at discharge.

Contribution

The study evaluates the effectiveness and feasibility of a discharge-focused antibiotic stewardship bundle in a large, real-world setting.

Findings

The stewardship bundle did not significantly reduce post-discharge antibiotic prescriptions or duration.

Inpatient antibiotic duration was shorter during the intervention, but no impact on length-of-stay or readmissions was observed.

Providers found the initiative acceptable, but stewardship teams faced challenges in identifying discharge timing.

Abstract

We evaluated whether an antibiotic stewardship bundle, which included audit-and-feedback, could reduce antibiotic overuse at hospital discharge.

We performed a stepped-wedge cluster randomized trial across participating units at 10 hospitals to evaluate the effect of a discharge-focused stewardship bundle. The trial ran from 12/5/22-11/17/23. After a 24-week baseline period, one hospital crossed into the intervention arm every 2 weeks. The intervention consisted of a) disseminating institutional guidelines for oral antibiotic step-down therapy; and b) prospective audit-and-feedback on inpatients receiving antibiotics who had an anticipated discharge in the next 48 hours. The primary outcome was post-discharge antibiotic use. Secondary outcomes included inpatient antibiotic use, length-of-stay, and readmissions. After the intervention ended, providers and stewardship personnel from each hospital were surveyed and interviewed, respectively, to assess acceptability and feasibility.

There were 21,782 patient-admissions included (14,228 baseline period; 7,554 intervention period). Median age was 66 years, with 61% male (Table 1). At the hospital-level, the average number of patients audited per week was 20; one-quarter of audits led to feedback. There were 3,133 (21.9%) patients prescribed post-discharge antibiotics at baseline compared to 1,645 (21.8%) during the intervention (OR 1.02; 95% CI 0.95-1.09). The mean post-discharge duration was 7.1 days (SD 5.2) at baseline compared to 7.6 days (SD 5.6) during the intervention (RR 1.02; 95% CI 0.98-1.07). Inpatient antibiotic duration was shorter during the intervention (RR 0.91; 95% CI 0.86-0.97), but there was no difference in length-of-stay and readmissions (Table 2). One hundred twelve inpatient providers were sent a post-intervention survey; 40 (35.7%) responded; 94% felt that the initiative improved antibiotic-prescribing at discharge (Table 3). However, many stewardship teams reported difficulty in accurately identifying when patients would be discharged (Table 4).

An antibiotic stewardship bundle, which included audit-and-feedback, did not reduce antibiotic use at discharge. The bundle was acceptable to providers but difficult for stewardship teams to implement.

Yvonne Burnett, PharmD, BCIDP, InflaRx: Honoraria|Melinta Therapeutics: Honoraria

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