Towards Data-Driven Hospital Antimicrobial Stewardship: Secondary use of Routine Electronic Care and Prescribing Records to Inform Antimicrobial Stewardship Programmes

Abstract

Background Hospital antimicrobial stewardship (AMS) programmes are multidisciplinary initiatives to optimise the use of antimicrobials. Most AMS programmes rely on time-consuming manual audits to monitor clinicians’ antibiotic prescribing practice. Much of the information needed is already contained within electronic health records (EHRs) and could be used to inform AMS programmes. The objective of this study was to evaluate the feasibility of building analytics from hospital EHRs to facilitate AMS interventions. Methods This study used electronic prescribing, laboratory and clinical coding records of adult patients admitted to six specialties at Queen Elizabeth Hospital, Birmingham, UK between September 2017 and August 2018 (n = 61,679 admissions). Duration of prescribing, compliance with clinical guidelines, and timing of switch from intravenous to oral antibiotics in relation to clinical progression were assessed. Outputs were visualised at ward, specialty and consultant levels. Results A total of 59,884 antibacterial prescription records were linked into 24,653 therapy episodes. Among the 35% of admissions prescribed an antibacterial, the mean days of therapy per admission was 4.3 days and 9.9 days in elective and emergency hospitalisations respectively. Twenty-two percent (207/997) of therapy episodes for low-severity community-acquired pneumonia were initiated with the antibiotic recommended by locally-approved prescribing guidelines. Data suggested average delays in switching from intravenous to oral therapy of up to 3.6 days [95% CI: 3.4; 3.7]. Microbial cultures were performed prior to treatment initiation in just 22% of antibacterial prescriptions. Conclusions Hospital EHRs can be used to construct meaningful measures of antibiotic stewardship, demonstrating potential value for audit and feedback interventions.