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Abstract
Background Early transition of parenteral (IV) to enteral antibiotics is recommended to decrease hospital length of stay and healthcare costs. Without clear criteria to guide transition, patients at our hospital often remained on IV antibiotics until discharge despite clinical improvement.
Objectives Increase the percentage of timely-transitioned anti-biotic doses (total enteral antibiotic doses divided by all anti-biotic doses in patients receiving other enteral medications) for Hospital Medicine (HM) patients admitted for uncomplicated pneumonia or skin and soft tissue infections (SSTI) from 44% to 75% by August 31, 2017.
Methods Improvement efforts targeted five HM teams at a large paediatric academic hospital. Our multidisciplinary team included HM attendings, fellows, residents, and pharmacists. Several key drivers (Figure 1) informed our interventions. Interventions included education on IV and enteral antibiotic cost differential, incorporation of antibiotic transition plan in electronic health record (EHR) note templates, structured discussions of transition criteria for patients on IV antibiotics, and real-time identification of failures and feedback. An automated system that interfaced with our EHR provided data on medication administration route and missed opportunities for timely-transitioned antibiotic doses. An annotated statistical process control chart assessed the impact of interventions over time (figure 2).
Results The percentage of timely-transitioned antibiotic doses increased from 44% to 80% within 8 months. The most effective interventions were early identification of transition criteria through structured huddles and real-time identification and mitigation of failures.
Conclusions Identification of clear criteria for transition from IV to enteral antibiotics can increase timely transitions for patients with uncomplicated pneumonia and SSTI.
Key driver diagram
Control chart