Robert Hiensch1, Jashvant Poeran2, Patricia Saunders-Hao3, Victoria Adams3, Charles A Powell4, Allison Glasser5, Madhu Mazumdar2, Gopi Patel6. 1. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: robert.hiensch@mountsinai.org. 2. Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. 3. Department of Pharmacy, The Mount Sinai Hospital, New York, NY. 4. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 5. Office for Excellence in Patient Care, Icahn School of Medicine at Mount Sinai, New York, NY. 6. Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.
Abstract
BACKGROUND: Although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. We aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (HCFO) Clostridium difficile infection (CDI) rates. METHODS: We used interrupted time series data from a large, tertiary, urban academic medical center including all adult inpatients on 4 medicine wards (June 2011-July 2014). The main exposure was implementation of the sepsis screening program; the main outcomes were the use of broad-spectrum antibiotics (including 3 that were part of an order set designed for the sepsis initiative) and HCFO CDI rates. Segmented regression analyses compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative. RESULTS: Antibiotic use and HFCO CDI rates increased during the period of implementation and the period after implementation compared with baseline; these increases were highest in the period after implementation (level change, 50.4 days of therapy per 1,000 patient days for overall antibiotic use and 10.8 HCFO CDIs per 10,000 patient days; P < .05). Remarkably, the main drivers of overall antibiotic use were not those included in the sepsis order set. CONCLUSIONS: The implementation of an electronic sepsis screening and treatment protocol coincided with increased broad-spectrum antibiotic use and HCFO CDIs. Because these protocols are increasingly used, further study of their unintended consequences is warranted.
BACKGROUND: Although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. We aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (HCFO) Clostridium difficileinfection (CDI) rates. METHODS: We used interrupted time series data from a large, tertiary, urban academic medical center including all adult inpatients on 4 medicine wards (June 2011-July 2014). The main exposure was implementation of the sepsis screening program; the main outcomes were the use of broad-spectrum antibiotics (including 3 that were part of an order set designed for the sepsis initiative) and HCFO CDI rates. Segmented regression analyses compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative. RESULTS: Antibiotic use and HFCO CDI rates increased during the period of implementation and the period after implementation compared with baseline; these increases were highest in the period after implementation (level change, 50.4 days of therapy per 1,000 patient days for overall antibiotic use and 10.8 HCFO CDIs per 10,000 patient days; P < .05). Remarkably, the main drivers of overall antibiotic use were not those included in the sepsis order set. CONCLUSIONS: The implementation of an electronic sepsis screening and treatment protocol coincided with increased broad-spectrum antibiotic use and HCFO CDIs. Because these protocols are increasingly used, further study of their unintended consequences is warranted.
Authors: Xuan Han; Alexandra Spicer; Kyle A Carey; Emily R Gilbert; Neda Laiteerapong; Nirav S Shah; Christopher Winslow; Majid Afshar; Markos G Kashiouris; Matthew M Churpek Journal: Crit Care Med Date: 2021-10-01 Impact factor: 9.296
Authors: Khalia Ackermann; Jannah Baker; Malcolm Green; Mary Fullick; Hilal Varinli; Johanna Westbrook; Ling Li Journal: J Med Internet Res Date: 2022-02-23 Impact factor: 7.076
Authors: Chanu Rhee; Sameer S Kadri; John P Dekker; Robert L Danner; Huai-Chun Chen; David Fram; Fang Zhang; Rui Wang; Michael Klompas Journal: JAMA Netw Open Date: 2020-04-01
Authors: Lucas M Fleuren; Thomas L T Klausch; Charlotte L Zwager; Linda J Schoonmade; Tingjie Guo; Luca F Roggeveen; Eleonora L Swart; Armand R J Girbes; Patrick Thoral; Ari Ercole; Mark Hoogendoorn; Paul W G Elbers Journal: Intensive Care Med Date: 2020-01-21 Impact factor: 17.440