Feasibility study of hospital antimicrobial stewardship analytics using electronic health records. Issue 1 (4th March 2021)

• Record Type: Journal Article
• Authors: Dutey-Magni, P F; Gill, M J; McNulty, D; Sohal, G; Hayward, A; Shallcross, L; Anderson, Niall; Crayton, Elise; Forbes, Gillian; Jhass, Arnoupe; Richardson, Emma; Richardson, Michelle; Rockenschaub, Patrick; Smith, Catherine; Sutton, Elizabeth; Traina, Rosanna; Atkins, Lou; Conolly, Anne; Denaxas, Spiros; Fragaszy, Ellen; Horne, Rob; Kostkova, Patty; Lorencatto, Fabiana; Michie, Susan; Mindell, Jennifer; Robson, John; Royston, Claire; Tarrant, Carolyn; Thomas, James; West, Jonathan; Williams, Haydn; Elsay, Nadia; Fuller, Chris;
• Is Part Of: JAC-antimicrobial resistance. Volume 3:Issue 1(2021)
• Publication Date: 2021-03-04
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; Drug resistance in microorganisms -- Periodicals; 616.9041
• DOI: 10.1093/jacamr/dlab018
• Languages: English
• ISSNs: 2632-1823

Abstract

Abstract: Background: Hospital antimicrobial stewardship (AMS) programmes are multidisciplinary initiatives to optimize antimicrobial use. Most hospitals depend on time-consuming manual audits to monitor clinicians' prescribing. But much of the information needed could be sourced from electronic health records (EHRs). Objectives: To develop an informatics methodology to analyse characteristics of hospital AMS practice using routine electronic prescribing and laboratory records. Methods: Feasibility study using electronic prescribing, laboratory and clinical coding records from adult patients admitted to six specialities at Queen Elizabeth Hospital, Birmingham, UK (September 2017–August 2018). The study involved: (i) a review of AMS standards of care; (ii) their translation into concepts measurable from commonly available EHRs; and (iii) a pilot application in an EHR cohort study ( n = 61679 admissions). Results: We developed data modelling methods to characterize antimicrobial use (antimicrobial therapy episode linkage methods, therapy table, therapy changes). Prescriptions were linked into antimicrobial therapy episodes (mean 2.4 prescriptions/episode; mean length of therapy 5.8 days), enabling several actionable findings. For example, 22% of therapy episodes for low-severity community-acquired pneumonia were congruent with prescribing guidelines, with a tendency to use broader-spectrum antibiotics. Analysis of therapy changes revealed IV to oral therapy switching was delayed by an average 3.6 days (95% CI: 3.4–3.7). Microbial cultures were performed prior to treatment initiation in just 22% of antibacterial prescriptions. The proposed methods enabled fine-grained monitoring of AMS practice down to specialities, wards and individual clinical teams by case mix, enabling more meaningful peer comparison. Conclusions: It is feasible to use hospital EHRs to construct rapid, meaningful measures of prescribing quality with potential to support quality improvement interventions (audit/feedback to prescribers), engagement with front-line clinicians on optimizing prescribing, and AMS impact evaluation studies.