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Implementation of Electronic Clinical Decision Support Tools for Antibiotic Stewardship in Pediatric Appendicitis

Kathleen Marulanda1, Zachary Willis2, William Wilson3

  • 1Department of Surgery, 6797University of North Carolina, Chapel Hill, NC, USA.

The American Surgeon
|February 3, 2021
PubMed

Insights

An electronic order panel improved antibiotic stewardship in pediatric appendicitis by increasing narrow-spectrum antibiotic use. However, order panel utilization remained low, questioning its value as a quality improvement metric.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Clinical Decision Support Systems

Background:

  • Efficacy of clinical decision support (CDS) tools for antibiotic stewardship in pediatric appendicitis is not well-established.
  • An electronic order panel (OP) was developed to reduce broad-spectrum antibiotic use.

Purpose of the Study:

  • To evaluate the impact of an electronic order panel on antibiotic prescribing patterns for pediatric appendicitis.
  • To assess the effectiveness of CDS tools in promoting antibiotic stewardship.

Main Methods:

  • Retrospective review of patients (≤18 years) treated for appendicitis from May 2018 to October 2019.
  • Comparison of antibiotic use between pre-implementation (PIC) and post-implementation (PISC) cohorts.

Main Results:

  • Post-implementation cohort showed a 50% increase in preferred (narrow-spectrum) antibiotic use (92% vs 42%, P = .014).
  • Order panel utilization was 31% of overall encounters and 44% of PISC encounters.

Conclusions:

  • The electronic order panel led to sustained improvements in antibiotic stewardship.
  • Low order panel utilization suggests CDS tools may not be ideal process measures for quality improvement.
Abstract

Keywords:
antibiotic stewardshipclinical decision support systemspediatric appendicitisquality improvement

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