Impact of an electronic antibiotic time-out best practice alert on antibiotic use and prescribing behavior in...

Provider-directed electronic antibiotic time-outs (ATOs) are a stewardship strategy capable of efficient and widespread impact with relatively low perceived personnel effort. This is a multi-center, quasi-experimental, retrospective chart review of patients admitted receiving empiric antibiotics for >72 hours. An ATO alert was designed and embedded within the electronic medical record and set to fire between the hours of 07:00 and 16:30 daily. Seventy-two hours after a unique antibiotic order was entered, a best practice alert (BPA) would fire for the primary team-including the attending physician, residents, and advanced practice providers-as well as any infectious disease provider consulted at the time of ATO firing. This alert is triggered when entering or modifying orders as an active pop-up to the ordering prescriber. Prescribers were then prompted to assess the patient for potential antibiotic optimization-including discontinuation, de-escalation, and transition to oral therapies. A total of 800 patients receiving >72 hours of antibiotics were included for analysis. There was no statistically significant difference in the rate of antibiotic optimization when comparing the pre- and post-implementation cohort (54.5% vs 57.5%, P = 0.433); however, there was a numerically lower rate of antibiotic escalation in the post-cohort (9.5% vs 5.8%, P = 0.062). Duration of antibiotic therapy was longer in the post-implementation cohort (4.7 vs 5.0 days, P < 0.001). The implementation of an ATO BPA failed to improve the rates of antibiotic optimization.