Prospective Audit and Feedback by Antibiotic Stewardship Teams to Reduce Antibiotic Overuse at Hospital Discharge: A Stepped-Wedge Cluster-Randomized Clinical Trial
Abstract
Importance: Antibiotics prescribed at hospital discharge are frequently unnecessary or suboptimal. Strategies to improve prescribing are not well defined.
Objective: To evaluate whether a discharge-focused prospective audit and feedback process decreases antibiotic overuse at hospital discharge.
Design, setting, and participants: This stepped-wedge cluster-randomized clinical trial was conducted across participating units at 10 hospitals with antibiotic stewardship (AS) teams and supporting staff from December 5, 2022, to November 17, 2023. After a 24-week baseline period, 1 hospital crossed into the intervention arm every 2 weeks.
Intervention: The intervention consisted of disseminating institutional guidelines for oral antibiotic step-down to frontline prescribers and conducting a prospective audit and feedback process for inpatients receiving antibiotics with an anticipated discharge date in the next 48 hours.
Main outcomes and measures: The primary outcome was postdischarge antibiotic use. Secondary outcomes included inpatient antibiotic use, length of hospital stay, and readmission. Manual electronic health record reviews were performed in 434 cases to assess optimal antibiotic prescribing at discharge for patients who met specific criteria. Analysis was performed on a per-protocol basis.
Results: There were 21 842 patient admissions (baseline, 14 288; intervention, 7554) across 10 hospitals. The median (IQR) age was 66 (53-75) years, with 13 380 (61.3%) males. At the…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 3,133 participants or records.
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