A tailored implementation strategy to reduce the duration of intravenous antibiotic treatment in community-acquired pneumonia: a controlled before-and-after study

Autor: M. E. J. L. Hulscher, F. Teding van Berkhout, Andy I.M. Hoepelman, M. H. Emmelot-Vonk, E. M. Kuck, J. H. den Breeijen, R. K. Stellato, Sanjay U. C. Sankatsing, Carlo A. J. M. Gaillard, M. F. Engel, A. H. W. Bruns, M. H. M. Steeghs, Jan Jelrik Oosterheert
Přispěvatelé: Nephrology, ICaR - Circulation and metabolism, Groningen Kidney Center (GKC)
Rok vydání: 2014
Předmět:
Male
Pediatrics
Time Factors
Administration
Oral
GUIDELINES
THERAPY
law.invention
HOSPITALIZED-PATIENTS
Community-acquired pneumonia
Randomized controlled trial
law
Interquartile range
Behavior Therapy
Duration (project management)
Netherlands
Aged
80 and over
General Medicine
Middle Aged
CAP
Hospitals
Anti-Bacterial Agents
Community-Acquired Infections
Infectious Diseases
Treatment Outcome
Costs and Cost Analysis
Administration
Intravenous
Female
INTERVENTION
Microbiology (medical)
Adult
medicine.medical_specialty
EARLY SWITCH
MEDLINE
IMPROVEMENT
CONTROLLED-TRIAL
Case mix index
medicine
MANAGEMENT
Pneumonia
Bacterial
Humans
Aged
business.industry
Length of Stay
medicine.disease
Confidence interval
Pneumonia
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
ORAL ANTIBIOTICS
Controlled Before-After Studies
Emergency medicine
business
Zdroj: European Journal of Clinical Microbiology and Infectious Diseases, 33, 1897-908
Engel, M F, Bruns, A H W, Hulscher, M E J L, Gaillard, C A J M, Sankatsing, S U C, van Berkhout, F T, Emmelot-Vonk, M H, Kuck, E M, Steeghs, M H M, den Breeijen, J H, Stellato, R K, Hoepelman, A I M & Oosterheert, J J 2014, ' A tailored implementation strategy to reduce the duration of intravenous antibiotic treatment in community-acquired pneumonia: a controlled before-and-after study ', European Journal of Clinical Microbiology and Infectious Diseases, vol. 33, no. 11, pp. 1897-1908 . https://doi.org/10.1007/s10096-014-2158-z
European Journal of Clinical Microbiology and Infectious Diseases, 33, 11, pp. 1897-908
European Journal of Clinical Microbiology and Infectious Diseases, 33(11), 1897-1908. Springer Verlag
European Journal of Clinical Microbiology & Infectious Diseases, 33(11), 1897-1908. SPRINGER
ISSN: 1435-4373
0934-9723
DOI: 10.1007/s10096-014-2158-z
Popis: Item does not contain fulltext We previously showed that 40 % of clinically stable patients hospitalised for community-acquired pneumonia (CAP) are not switched to oral therapy in a timely fashion because of physicians' barriers. We aimed to decrease this proportion by implementing a novel protocol. In a multi-centre controlled before-and-after study, we evaluated the effect of an implementation strategy tailored to previously identified barriers to an early switch. In three Dutch hospitals, a protocol dictating a timely switch strategy was implemented using educational sessions, pocket reminders and active involvement of nursing staff. Primary outcomes were the proportion of patients switched timely and the duration of intravenous antibiotic therapy. Length of hospital stay (LOS), patient outcome, education effects 6 months after implementation and implementation costs were secondary outcomes. Statistical analysis was performed using mixed-effects models. Prior to implementation, 146 patients were included and, after implementation, 213 patients were included. The case mix was comparable. The implementation did not change the proportion of patients switched on time (66 %). The median duration of intravenous antibiotic administration decreased from 4 days [interquartile range (IQR) 2-5] to 3 days (IQR 2-4), a decrease of 21 % [95 % confidence interval (CI) 11 %; 30 %) in the multi-variable analysis. LOS and patient outcome were comparable before and after implementation. Forty-three percent (56/129) of physicians attended the educational sessions. After 6 months, 24 % (10/42) of the interviewed attendees remembered the protocol's main message. Cumulative implementation costs were 5,798 (20/reduced intravenous treatment day). An implementation strategy tailored to previously identified barriers reduced the duration of intravenous antibiotic administration in hospitalised CAP patients by 1 day, at minimal cost.
Databáze: OpenAIRE
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