P-941. Put a CAP on Antibiotics: Electronic Medical Record Tools Improve Antibiotic Prescribing at Discharge for Community Acquired Pneumonia

TL;DR

This study shows that adding electronic medical record tools helps doctors prescribe the right amount of antibiotics for pneumonia patients when they leave the hospital.

Contribution

The study demonstrates that EMR transitions of care tools can effectively reduce excessive antibiotic prescriptions for pneumonia patients.

Findings

Post-intervention, 73.7% of patients received less than 6 days of CAP therapy, compared to 53.6% pre-intervention.

Patients in the post-intervention group were prescribed shorter median antibiotic duration at discharge.

There were no differences in readmission rates or infections between the groups.

Abstract

Guidelines recommend that uncomplicated community acquired pneumonia (CAP) is treated for 5 days; however, patients are commonly prescribed excessive antibiotics at discharge. This study evaluated the impact of electronic medical record (EMR) transitions of care (TOC) tools on duration of therapy for uncomplicated CAP.Figure 1.Transitions of Care EMR ToolsFigure 2.Complicated CAP

Transitions of Care EMR Tools

Complicated CAP

IRB approved, single pre-, post-test quasi-experiment of hospitalized adult patients with uncomplicated CAP between 07/01/2023-11/30/2023 (pre-intervention) and 07/01/2024-11/30/2024 (post-intervention). EMR TOC tools implemented in March-May 2024, included total antibiotic days counter and inpatient stop date carry-over on discharge order (Figure 1). Patients who completed antibiotics prior to discharge date, admitted to intensive care unit, respiratory culture with methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa ≤ 12-months before admission, suspected concomitant infection, or complicated CAP (Figure 2) were excluded. The primary outcome was the proportion of patients prescribed < 6-calendar-days of total therapy for CAP. Secondary outcomes included 30-day CAP-related readmission and Clostridioides difficile infection (CDI), multidrug-resistant organisms (MDRO) ≤ 90-days of discharge, and days of therapy prescribed at discharge.Table 1.Patient DemographicsTable 2.Regression Analysis

Patient Demographics

Regression Analysis

A total of 239 patients were included; 125 patients in the pre-intervention period and 114 patients in the post-intervention period. Demographics are noted in Table 1. A higher proportion of patients in the post-intervention group received < 6-days of CAP therapy compared to the pre-intervention group (53.6% pre- vs. 73.7% post-intervention, P=0.001). There were no differences in readmission, CDI, or MDRO infection between groups. Post-intervention group patients were prescribed shorter median (IQR) antibiotic duration at discharge than pre-intervention group patients (3 [2-4] pre- vs. 2.5 [1-4] post-intervention, P< 0.001). After adjustments for confounders, patients in the post-intervention group had 2-fold increased odds of receiving < 6-days of therapy for CAP (Table 2).

Implementation of EMR TOC tools significantly improved optimal CAP prescribing in hospitalized adults, with no differences in patient outcomes.

All Authors: No reported disclosures

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