The feasibility of antimicrobial lead time as process and quality indicator for hospitals

Antimicrobial lead time (ALT) is the time from antimicrobial order to administration, an understudied parameter. This study aims to determine feasibility of retrieving ALT, differences in ALT for different infectious diseases and the association of ALT with length of stay (LoS) in order to establish the value of this parameter as potential new process or quality indicator (QI).

In a retrospective study in a tertiary care hospital in the Netherlands, adult hospitalized patients treated for an infection were included over a 20-month period. ALT was calculated with data from the electronic health record system with computerized provider order entry.

Thousand patients (56.1% men, median age 61 years) were included. The median ALT was 1.05 h and significantly shorter in septic patients (n = 65) than in patients with other infections (n = 935; 0.27 h, interquartile range (IQR) 0.07-0.67 vs. 1.18 h, IQR 0.37-3.15; p < 0.001). If blood cultures were obtained median ALT was shorter (0.85 h vs. 1.77 h; p < 0.001). ALT was not shorter in patients with positive compared to negative blood cultures (0.63 h vs. 0.94 h; p = 0.053). Antimicrobials ordered in the emergency room had a shorter median ALT than in medical wards (0.43 h vs. 1.57 h; p < 0.001). After correcting for indication, we found no association between ALT and LoS (p = 0.34).

ALT is an easily measurable QI for sepsis. More studies are needed to establish whether ALT is a feasible QI for meningitis and community-acquired pneumonia. For all infections, ALT can be used as process indicator for drug administration.