Trainee-Led Time-Outs Can Improve Antibiotic Use
WEDNESDAY, Nov. 19, 2014 (HealthDay News) -- Trainee-led time-outs to reevaluate antibiotic use can reduce costs in internal medicine units, according to a study published in a supplement to the Nov. 18 issue of the Annals of Internal Medicine, highlighting the Robert Wood Johnson Foundation Clinical Scholars Program.
Todd C. Lee, M.D., M.P.H., from the McGill University Health Center in Montreal, and colleagues conducted a before-after study among 679 internal medicine inpatients to optimize antibiotic use through U.S. Centers for Disease Control and Prevention-proposed trainee-led time-outs. Resident physicians adjusted patients' antibiotic therapy through time-out audits conducted twice weekly. After standardization, antibiotic costs were compared in the year before and after the audits.
The researchers observed a 46 percent reduction in total costs in the units, from $149,743CAD (January 2011 to January 2012) to $80,319 (January 2012 to January 2013). Seventy-eight and 22 percent of the savings were related to the carbapenems and other antibiotic classes, respectively. There was 80 percent adherence to the auditing process. The only reliable and statistically significant change in the time-series analysis was a reduction in the rate of moxifloxacin use, by −1.9 defined daily doses per 1,000 patient-days per month (P = 0.048). There was a decrease in the rates of Clostridium difficile infection from 24.2 to 19.6 per 10,000 patient-days (incidence rate ratio, 0.8; 95 percent confidence interval, 0.5 to 1.3).
"An antibiotic self-stewardship bundle to implement the CDC's suggested time-outs seems to have reduced overall costs and targeted antibiotic use," the authors write.