Antibiotic Review Kit for Hospitals (ARK-Hospital): study protocol for a stepped-wedge cluster-randomised controlled...

Area of Science:

• Healthcare intervention research
• Antimicrobial stewardship
• Behavioural science in medicine

Background:

• Current UK guidance promotes reviewing antibiotic use 24-72 hours after admission.
• Less than 10% of antibiotic prescriptions are discontinued at review, despite potential for 20-30% safe cessation.
• There is a need to safely reduce hospital antibiotic consumption while ensuring early patient access.

Purpose of the Study:

• To evaluate the Antibiotic Review Kit for Hospitals (ARK-Hospital) behavioural intervention.
• To determine if ARK-Hospital can safely reduce the total antibiotic burden in acute/general medical inpatients by at least 15%.
• To assess the intervention's impact on 30-day mortality and antibiotic defined daily doses per admission.

Main Methods:

• A complex behavioural intervention targeting healthcare professionals involved in antibiotic prescribing.
• A phased study including a feasibility trial, an internal pilot, and a cluster-randomised stepped-wedge trial (minimum 36 organisations).
• Data collected from adult inpatients admitted to acute/general medicine via electronic health records.

Main Results:

• The study is designed to determine if ARK-Hospital is non-inferior for 30-day mortality and superior in reducing antibiotic defined daily doses.
• The primary outcome is a minimum 15% reduction in total antibiotic burden for medical inpatients.
• The study will assess the feasibility, sustainability, and generalisability of the intervention.

Conclusions:

• ARK-Hospital is designed as a feasible and sustainable mechanism to improve antibiotic stewardship.
• The intervention aims to increase the safe discontinuation of antibiotics when no longer needed.
• Successful implementation could lead to significant reductions in hospital antibiotic use.