Impact of Clinical Decision Support System Implementation at a Community Hospital With an Existing Tele-Antimicrobial Stewardship Program

Abstract

Background Lack of on-site antimicrobial stewardship (AS) expertise is a barrier to establishing successful programs. Tele-antimicrobial stewardship programs (TASP) utilizing clinical decision support systems (CDSS) can address these challenges. Methods This interrupted time series study reports the impact of CDSS implementation (February 2020) within an existing TASP on antimicrobial usage in a community hospital. Segmented regression analysis was used to assess differences in antimicrobial usage from January 2018 through December 2021. Pre- and post-CDSS frequencies of intravenous versus oral antimicrobials, time to optimal therapy (TTOT), pharmacist efficiency (number of documented interventions per month), and percentage of hospitalized patients receiving antimicrobials were compared with descriptive statistics. Results Implementation of a CDSS into an existing TASP was associated with an immediate 11% reduction in antimicrobial usage (level change, p < 0.0001). Antimicrobial usage was already trending down by 0.25% per month (pre-CDSS slope, p < 0.0001) and continued to trend down at a similar rate after implementation (post-CDSS slope, p = 0.0129). Frequency of use of select oral agents increased from 38% to 57%. Median TTOT was one day faster (2.9 days pre-CDSS vs 1.9 days post-CDSS). On average, pharmacists documented 2.2-fold more interventions per month (198 versus 90) and patients received 1.03 less days of antimicrobials per admission post-CDSS. Conclusions Implementation of CDSS within an established TASP at a community hospital resulted in decreased antimicrobial usage, higher rates of oral usage, faster TTOT, and improved pharmacist efficiency.

Are physicians ready for precision antibiotic prescribing? A qualitative analysis of the acceptance of artificial intelligence-enabled clinical decision support systems in India and Singapore

“…Hospital antimicrobial stewardship programs were found to improve antibiotic use and antibiotic prescribing without compromising patient safety [12] . Rules-based clinical decision support systems (CDSSs) were developed to enhance clinical decisions, improve clinical outcomes, and reduce mortality by guiding doctors in selecting the most appropriate antibiotics for empiric therapy [13] , [14] , [15] , [16] . However, many physicians still prefer to exercise their professional judgement and tend to override the recommendations of CDSSs in complex patient situations [ 17 , 18 ].…”