Sl. Pestotnik et al., IMPLEMENTING ANTIBIOTIC PRACTICE GUIDELINES THROUGH COMPUTER-ASSISTEDDECISION-SUPPORT - CLINICAL AND FINANCIAL OUTCOMES, Annals of internal medicine, 124(10), 1996, pp. 884
Objective: To determine the clinical and financial outcomes of antibio
tic practice guidelines implemented through computer-assisted decision
support. Design: Descriptive epidemiologic study and financial analys
is. Setting: 520-bed community teaching hospital in Salt Lake City, Ut
ah. Patients: All 162 196 patients discharged from LDS Hospital betwee
n 1 January 1988 and 31 December 1994. Intervention: An antibiotic man
agement program that used local clinician-derived consensus guidelines
embedded in computer-assisted decision support programs. Prescribing
guidelines were developed for inpatient prophylactic, empiric, and the
rapeutic uses of antibiotics. Measurements: Measures of antibiotic use
included timing of preoperative antibiotic administration and duratio
n of postoperative antibiotic use. Clinical outcomes included rates of
adverse drug events, patterns of antimicrobial resistance, mortality,
and length of hospital stay. Financial and use outcomes were expresse
d as yearly expenditures for antibiotics and defined daily doses per 1
00 occupied bed-days. Results: During the 7-year study period, 63 759
hospitalized patients (39.3%) received antibiotics. The proportion of
the hospitalized patients who received antibiotics increased each year
, from 31.8% in 1988 to 53.1% in 1994. Use of broad-spectrum antibioti
cs increased from 24% of all antibiotic use in 1988 to 47% in 1994. Th
e annual Medicare case-mix index increased from 1.7481 in 1988 to 2.05
20 in 1993. Total acquisition costs of antibiotics (adjusted for infla
tion) decreased from 24.8% ($987 547) of the pharmacy drug expenditure
budget in 1988 to 12.9% ($612 500) in 1994. Antibiotic costs per trea
ted patient (adjusted for inflation) decreased from $122.66 per patien
t in 1988 to $51.90 per patient in 1994. Analysis using a standardized
method (defined daily doses) to compare antibiotic use showed that an
tibiotic use decreased by 22.8% overall. Measures of antibiotic use an
d clinical outcomes improved during the study period. The percentage o
f patients having surgery who received appropriately timed preoperativ
e antibiotics increased from 40% in 1988 to 99.1% in 1994. The average
number of antibiotic doses administered for surgical prophylaxis was
reduced from 19 doses in the base year to 5.3 doses in 1994. Antibioti
c-associated adverse drug events decreased by 30%. During the study, a
ntimicrobial resistance patterns were stable, and length of stay remai
ned the same. Mortality rates decreased from 3.65% in 1988 to 2.65% in
1994 (P < 0.001). Conclusions: Computer-assisted decision support pro
grams that use local clinician-derived practice guidelines can improve
antibiotic use, reduce associated costs, and stabilize the emergence
of antibiotic-resistant pathogens.