Outcomes of multisite antimicrobial stewardship programme implementation with a shared clinical decision support...

Area of Science:

• Health Services Research
• Infectious Disease Epidemiology
• Health Informatics

Background:

• Previous studies on antimicrobial stewardship programs (ASPs) with computerized clinical decision support systems (CDSSs) were mostly single-site.
• This study addresses the gap by examining multisite ASP implementation using a central CDSS.

Purpose of the Study:

• To evaluate the outcomes of a multisite antimicrobial stewardship program (ASP) supported by a centrally deployed computerized clinical decision support system (CDSS).

Main Methods:

• An interrupted time series study was conducted across five Australian hospitals from 2010 to 2014.
• Key outcomes analyzed included antimicrobial use, costs, healthcare-associated Clostridium difficile infection (HCA-CDI) rates, length of stay (LOS), and standardized mortality ratios (SMRs).

Main Results:

• Post-intervention, targeted antimicrobial use showed significant changes, with increased use rising by 32% and decreased use falling by 23%.
• Antimicrobial costs initially decreased but later increased, while HCA-CDI rates significantly decreased.
• No significant increase in infection-related length of stay or mortality was observed.

Conclusions:

• Collaborative multisite ASP implementation with a central CDSS effectively reduced HCA-CDI rates and antimicrobial costs.
• The intervention demonstrated no negative impact on patient length of stay or mortality.
• Sustained impact requires ongoing targeted interventions.