Summary

An observational study was conducted at a hospital in the Rocky Mountain West to determine the clinical and financial outcomes of antibiotic guidelines implemented through computer-assisted support. Data were collected on all 162,000 patients discharged during 1988-94; of these patients, 64,000 received antibiotics. Results show that while the proportion of hospitalized patients receiving antibiotics increased each year, total antibiotic acquisition expenditures decreased both absolutely and as a percentage of the pharmacy drug budget, antibiotic expenditures per treated patient decreased, and antibiotic-associated adverse drug events and mortality decreased.

Primary Objective

Determine the clinical and financial outcomes of antibiotic guidelines implemented through computer-assisted support.

Methods

1. Data were collected on all 162,000 patients discharged during 1988-94; of these patients, 64,000 received antibiotics.
   

2. An antibiotic management program was implemented in 1994 that used local clinician-derived consensus guidelines embedded in computer-assisted decision support programs, including prescribing guidelines developed for inpatient prophylactic, empiric, and therapeutic use of antibiotics.
   

3. Antibiotic use process measures included timing of preoperative antibiotic administration and duration of post-operative antibiotic use.
   

4. Clinical outcomes measures included rates of adverse drug events, patterns of antimicrobial resistance, mortality, and length of stay.
   

5. Financial and use outcome measures included yearly expenditures for antibiotics and defined daily doses per 100 occupied bed-days.

Results

1. The proportion of hospitalized patients receiving antibiotics increased each year from 32% in 1988 to 53% in 1994.
   

2. Broad-spectrum antibiotic use increased from 24% of all antibiotic use in 1988 to 47% in 1994.
   

3. Total antibiotic acquisition expenditures (inflation adjusted) decreased from 25% ($988,000) of pharmacy drug budget in 1988 to 13% ($612,500) in 1994.
   

4. Defined daily doses of antibiotic per 100 occupied bed-days decreased 23% overall.
   

5. The percentage of surgery patients receiving surgical wound infection antibiotic prophylaxis within two hours before surgical incision (the optimum time) increased from 40% in 1988 to 99.1% in 1994.
   

6. The average number of antibiotic doses administered for surgical wound infection prophylaxis was reduced from 19 doses in 1988 to 5.3 doses in 1994.

Impact

Antibiotic-associated adverse drug events decreased 30%, and mortality decreased 27% (from 3.65% in 1988 to 2.65% in 1994). Antibiotic expenditures (inflation adjusted) per treated patient decreased 58% (from $123 in 1988 to $52 in 1994) for an $823,000 savings in 1994 (Annals Internal Medicine 124:10, May 15, 1996:884-890).