Feasibility study of hospital antimicrobial stewardship analytics using electronic health records.

PF Dutey-Magni ORCID logo ; MJ Gill ; D McNulty ; G Sohal ; A Hayward ; L Shallcross ORCID logo ; Niall Anderson ; Elise Crayton ; Gillian Forbes ; Arnoupe Jhass ; +23 more... Emma Richardson ; Michelle Richardson ; Patrick Rockenschaub ; Catherine Smith ; Elizabeth Sutton ; Rosanna Traina ; Lou Atkins ; Anne Conolly ; Spiros Denaxas ; Ellen Fragaszy ORCID logo ; Rob Horne ; Patty Kostkova ; Fabiana Lorencatto ; Susan Michie ; Jennifer Mindell ; John Robson ; Claire Royston ; Carolyn Tarrant ; James Thomas ; Jonathan West ; Haydn Williams ; Nadia Elsay ; Chris Fuller ; (2021) Feasibility study of hospital antimicrobial stewardship analytics using electronic health records. JAC-Antimicrobial Resistance, 3 (1). dlab018-. ISSN 2632-1823 DOI: 10.1093/jacamr/dlab018
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BACKGROUND: Hospital antimicrobial stewardship (AMS) programmes are multidisciplinary initiatives to optimize antimicrobial use. Most hospitals depend on time-consuming manual audits to monitor clinicians' prescribing. But much of the information needed could be sourced from electronic health records (EHRs). OBJECTIVES: To develop an informatics methodology to analyse characteristics of hospital AMS practice using routine electronic prescribing and laboratory records. METHODS: Feasibility study using electronic prescribing, laboratory and clinical coding records from adult patients admitted to six specialities at Queen Elizabeth Hospital, Birmingham, UK (September 2017-August 2018). The study involved: (i) a review of AMS standards of care; (ii) their translation into concepts measurable from commonly available EHRs; and (iii) a pilot application in an EHR cohort study (n = 61679 admissions). RESULTS: We developed data modelling methods to characterize antimicrobial use (antimicrobial therapy episode linkage methods, therapy table, therapy changes). Prescriptions were linked into antimicrobial therapy episodes (mean 2.4 prescriptions/episode; mean length of therapy 5.8 days), enabling several actionable findings. For example, 22% of therapy episodes for low-severity community-acquired pneumonia were congruent with prescribing guidelines, with a tendency to use broader-spectrum antibiotics. Analysis of therapy changes revealed IV to oral therapy switching was delayed by an average 3.6 days (95% CI: 3.4-3.7). Microbial cultures were performed prior to treatment initiation in just 22% of antibacterial prescriptions. The proposed methods enabled fine-grained monitoring of AMS practice down to specialities, wards and individual clinical teams by case mix, enabling more meaningful peer comparison. CONCLUSIONS: It is feasible to use hospital EHRs to construct rapid, meaningful measures of prescribing quality with potential to support quality improvement interventions (audit/feedback to prescribers), engagement with front-line clinicians on optimizing prescribing, and AMS impact evaluation studies.


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