Improving Post-discharge Antimicrobial Use

NCT05471726 | Completed

• 1 other identifier: IRB 202109288
• Study Type: interventional
• Target: 10
• Locations: 1 country
• Sites: 5

Brief Summary

One in five hospitalized patients is prescribed an antimicrobial at the time of discharge, and a large proportion of these post-discharge antimicrobials are unnecessary. The investigators will evaluate a novel method for reviewing post-discharge antimicrobial prescriptions in real-time with the goal of improving antimicrobial selection and duration.

Conditions

Infections

Keywords

antibiotic prescriptions; hospital discharge; antibiotic stewardship

Outcome Measures

Primary Outcomes (1)

• Post-discharge antibiotic length of therapy

  The primary outcome will be post-discharge antimicrobial length of therapy (LOT) per 100 admissions. The investigators will calculate this by adding post-discharge LOT across all patients on the participating services and dividing by the number of patient-admissions discharged from those services during the study period.

  Every 2-week-period through study completion (48 weeks total)

Secondary Outcomes (2)

• Inpatient antibiotic length of therapy

  Every two-week period through study completion (48 weeks total)

• Percentage of participants with hospital readmission

  30 days from discharge

Study Arms (2)

Prospective audit-and-feedback at discharge

EXPERIMENTAL

When hospitals are in the intervention arm, they will perform the audit-and-feedback process focused on patients receiving antimicrobials who have an anticipated discharge.

Behavioral: Prospective audit-and-feedback

Standard of care

NO INTERVENTION

When hospitals are in the control arm, they will not perform a stewardship process that focuses on hospital discharge.

Interventions

Prospective audit-and-feedback BEHAVIORAL

The stewardship team will review patients who are on antibiotics, have an uncomplicated infection, and are eligible to continue antibiotics after discharge. Any recommendations from the stewardship team about optimizing antibiotic therapy will be presented to the primary prescriber in real-time with the goal of improving antibiotic selection and duration at hospital discharge.

Prospective audit-and-feedback at discharge

Eligibility Criteria

• Age: 18 Years+
• Gender Eligibility Details: All patients on a participating inpatient service at the participating hospitals will be included, regardless of gender, race, or age.
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• The local stewardship team agrees to implement the discharge stewardship intervention on at least one inpatient service or ward.

You may not qualify if:

• The hospital already has an audit-and-feedback process in place that focuses on antimicrobial prescribing at hospital discharge.

Sponsors & Collaborators

• Iowa City Veterans Affairs Medical Center: lead
• Centers for Disease Control and Prevention: collaborator

Study Sites (5)

Richard Roudebush VA Medical Center

Indianapolis, Indiana, 46202, United States

Location

University of Iowa Hospitals and Clinics

Iowa City, Iowa, 52242, United States

Location

Baltimore VA Medical Center

Baltimore, Maryland, 21201-1524, United States

Location

Barnes Jewish Hospital and affiliated hospitals

St Louis, Missouri, 63110, United States

Location

Audie L Murphy VA Medical Center

San Antonio, Texas, 78229, United States

Location

Related Publications (1)

• Livorsi DJ, Thompson AM, Green MS, Hoelscher AC, Chu KK, Neuner E, Burnett Y, Hopkins T, Walter E, Dave R, Tripathi R, Lohmar H, Dysangco A, Percival K, Ince D, Kolkmeyer J, Newland H, Hendrix MJ, Clore G, Poe C, O'Shea A, Tholany J, Prasidthrathsint K, Rachmiel E, Bongu J, Bewley A, Hsueh K. Prospective Audit and Feedback by Antibiotic Stewardship Teams to Reduce Antibiotic Overuse at Hospital Discharge: A Stepped-Wedge Cluster-Randomized Clinical Trial. JAMA Netw Open. 2026 Jan 2;9(1):e2549655. doi: 10.1001/jamanetworkopen.2025.49655.

  PMID: 41511774 DERIVED

MeSH Terms

Conditions

Infections

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SEQUENTIAL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: Stepped-wedge

Study Record Dates

• First Submitted: July 13, 2022
• First Posted: July 25, 2022
• Study Start: May 22, 2023
• Primary Completion: November 19, 2023
• Study Completion: September 9, 2024
• Last Updated: October 8, 2024

Record last verified: 2024-10

Data Sharing

• IPD Sharing: Will not share

Locations

US (5)