Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-06-22T20:00:30.616Z Has data issue: false hasContentIssue false
  • English
  • Français

Intervention to Discontinue Parenteral Antimicrobial Therapy in Patients Hospitalized with Pulmonary Infections: Effect on Shortening Patient Stay

Published online by Cambridge University Press:  21 June 2016

N. Joel Ehrenkranz ,
Debra E. Nerenberg ,
James M. Shultz  and
Kenneth C. Slater
N. Joel Ehrenkranz*
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
Debra E. Nerenberg
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
James M. Shultz
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
Kenneth C. Slater
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
*
5901 S. W. 74th Street, Suite 300, South Miami, FL 33143
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Current efforts to contain antimicrobial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stay

Methods:

A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians with nonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials. Blinded observers evaluated in-hospital and 30-day postdischarge courses of patients of physicians who had been contacted by the nurse (cases) and those who had not (controls).

Results:

Eighty-two patient episodes (47 physicians) met study criteria. There were 53 cases and 29 controls. In 42 of 53 (79%) case episodes, physicians discontinued parenteral antimicrobials; patients' mean length of stay was 2.4 days less than for 29 control episodes (estimated cost savings was $884/patient). In 11 (21%) episodes, case physicians continued parenteral therapy; patients' mean length of stay was 1.9 days longer than for controls (estimated cost excess was $704/patient). Education, training and practice characteristics were comparable in physician groups. Severity of illness indicators and postdischarge outcomes were comparable in patient groups.

Conclusions:

The major cost-saving potential for shifting from par-enter-al to oral antimicrobial therapy is shortened length of stay. Timely information about alternative drug therapies, offered on a patient-specific basis, appears to modify the treating behavior of physicians. The program as currently conducted is cost-effective, with an estimated net savings of $50,000 per 100 interventions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 1 , January 1992 , pp. 21 - 32
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Avom, J, Soumerai, SB. Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based ‘detailing.’ N Engl J Med. 1983;308:1457–1461.Google Scholar
2. Schaffner, W, Ray, WA, Federspiel, CF, Miller, WO. Improving antibiotic prescribing in office practice: a controlled trial of three educational methods. JAMA. 1983;250:1728–1732.CrossRefGoogle ScholarPubMed
3. Landgren, FT. Harvey, KJ, Mashford, ML, Moulds, RFW, Guthrie, B, Hemming, M. Changing antibiotic prescribing by educational marketing. Med J Aust. 1988;149:595–599.10.5694/j.1326-5377.1988.tb120797.xCrossRefGoogle ScholarPubMed
4. Parrino, TA. The nonvalue of retrospective peer comparison feedback in containing hospital antibiotic costs. Am J Med. 1989;86:442–448.10.1016/0002-9343(89)90343-4CrossRefGoogle ScholarPubMed
5. Ehrenkranz, NJ. The efficacy of a Florida Hospital Consortium for Infection Control: 1975–1982. Infect Control. 1986;7:321–326.CrossRefGoogle Scholar
6. Klimek, JJ, Ajemian, E, Fontecchio, S, Gracewski, J, Klemas, B, Jimenez, L. Community-acquired bacterial pneumonia requiring admission to hospital. Am J Infect Control. 1983;11:79–82.CrossRefGoogle ScholarPubMed
7. Ehrenkranz, NJ. South Florida Hospital Consortium for Infection Control: structure and function. Am J infect Control. 1987;15:36–41.10.1016/0196-6553(87)90076-9CrossRefGoogle Scholar
8. Helbing, C, Keene, R. Use and cost of short-stay hospital inpatient services under Medicare, 1986. Health Care Financing Review. 1989;10:93–109.Google ScholarPubMed
9. Latta, VB, Kaene, RE. Use and cost of short-stay hospital inpatient services under Medicare, 1988 . Health Care Financing Review. 1990;12:91–99.Google ScholarPubMed
10. 1989 Red Book. Oradell, NJ: Medical Economics Co. Inc; 1989.Google Scholar
11. Fang, G-D, Fine, M, Orloff, J, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy. Medicine. 1990;69:307–316.CrossRefGoogle ScholarPubMed
12. Louie, M, Dyck, B, Parker, S, Sekla, L, Nicolle, LE. Nosocomial pneumonia in a Canadian tertiary care center: a prospective surveillance study. infect Control Hosp Epidemiol. 1991;12:356–363.Google Scholar
13. Soumerai, SB, Avorn, J. Predictors of physician prescribing change in an educational experiment to improve medication use. Med Care. 1987;25:210–221.10.1097/00005650-198703000-00005CrossRefGoogle Scholar
14. Fleiss, JL. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: John Wiley and Sons; 1981.Google Scholar
15. Ray, WA, Schaffner, W, Federspiel, CF. Persistence of improvement in antibiotic prescribing in office practice. JAMA. 1985;253:1774–1776.CrossRefGoogle ScholarPubMed
16. Siegel, BR, Mahan, CS, Witte, JJ, Janowski, HT. Influenza and pneumonococcal pneumonia immunization, protecting our high-risk population. J Fla Med Assoc. 1990;77:593–595.Google Scholar
17. Williams, RR, Gross, PA, Levine, JE Cost-containment of the second-generation cephalosporins by prospective monitoring at a community teaching hospital. JAMA. 1979;241:2283–2286.Google Scholar
18. Avorn, J, Soumerai, SB, Taylor, W, Wessels, MR, Janousek, J, Weiner, M. Reduction of incorrect antibiotic dosing through a structured educational order form. Arch Intern Med. 1988;148:1720–1724.CrossRefGoogle ScholarPubMed
19. Everitt, DE, Soumerai, SB, Avorn, J, Klapholz, H, Wessels, M. Changing surgical antimicrobial prophylaxis practices through education targeted at senior department leaders. Infect Control Hosp Epidemiol. 1990;11:578–583.CrossRefGoogle ScholarPubMed
20. Recco, RA, Gladstone, JL, Friedman, SA, Gerken, EH. Antibiotic control in a municipal hospital. JAMA. 1979;241:2283–2286.CrossRefGoogle Scholar
21. Woodward, RS, Medoff, G, Smith, MD, Gray, JL. Antibiotic cost savings from formularly restrictions and physician monitoring in a medical school-affiliated hospital. Am J Med. 1978;83:817–823.10.1016/0002-9343(87)90636-XCrossRefGoogle Scholar
22. Hirschman, SZ, Meyers, BR, Bradbury, K, Mehl, B, Gendelman, S, Kimelblatt, B. Use of antimicrobial agents in a university teaching hospital, evolution of a comprehensive control program. Arch Intern Med. 1988;148:2001–2007.CrossRefGoogle Scholar
23. Smith, KS, Briceland, LL, Nightingale, CH, Quintiliani, R. Formularly conversion of cefoxitin usage to cefotetan: experience at a large teaching hospital. Drug Intelligence and Clinical Pharmacy, The Annals of Pharmacotherapy. 1989;23:1024–1030.Google Scholar
24. Strong, DK, Dupuis, LL, Domaratzki, JL. Pharmacist intervention in prescribing of cefuroxime for pediatric patients. Am J Hosp Pharm. 1990;47:1350–1353.Google ScholarPubMed
25. Buchwald, D, Soumerai, SB, Vandevanter, N, Wessels, MR, Avorn, J. Effects of hospital-wide change in clindamycin dosing schedule on clinical outcome. Rev Infect Dis. 1989;11:619–624.CrossRefGoogle Scholar

A correction has been issued for this article:

Corrections