ArticleBMC health services research2012
Empiric antibiotic, mechanical ventilation, and central venous catheter duration as potential factors mediating the effect of a checklist prompting intervention on mortality: an exploratory analysis.
Article in BMC health services research, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.Intensive care medicine · 2020Guideline
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Interventions to improve antibiotic prescribing practices for hospital inpatients.The Cochrane database of systematic reviews · 2017Pooled it
- Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization.Critical care medicine · 2013Trial
- Impact of an electronic alert on prescription patterns of meropenem, voriconazole and caspofungin.BMC infectious diseases · 2021Article
- Predictive modeling of bacterial infections and antibiotic therapy needs in critically ill adults.Journal of biomedical informatics · 2020Article
- Considerations for Empiric Antimicrobial Therapy in Sepsis and Septic Shock in an Era of Antimicrobial Resistance.The Journal of infectious diseases · 2020Article
- Educational Strategies for Training in Quality Improvement and Implementation Medicine.ATS scholar · 2020Article
- Antimicrobial Susceptibility Testing of Antimicrobial Peptides to Better Predict Efficacy.Frontiers in cellular and infection microbiology · 2020Review
- Review
- Rules of anti-infection therapy for sepsis and septic shock.Chinese medical journal · 2019Review
- Bacterial sepsis : Diagnostics and calculated antibiotic therapy.Der Anaesthesist · 2019Review
- [Bacterial sepsis : Diagnostics and calculated antibiotic therapy].Der Anaesthesist · 2017Review
- Implementation of a CKD checklist for primary care providers.Clinical journal of the American Society of Nephrology : CJASN · 2014Article
- Prompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU?Current opinion in critical care · 2013Review
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundChecklists are clinical decision support tools that improve process of care and patient outcomes. We previously demonstrated that prompting critical care physicians to address issues on a daily rounding checklist that were being overlooked reduced utilization of empiric antibiotics and mechanical ventilation, and reduced risk-adjusted mortality and length of stay. We sought to examine the degree to which these process of care improvements explained the observed difference in hospital mortality between the group that received prompting and an unprompted control group.
methodsIn the medical intensive care unit (MICU) of a tertiary care hospital, we conducted face-to-face prompting of critical care physicians if processes of care on a checklist were being overlooked. A control MICU team used the checklist without prompting. We performed exploratory analyses of the mediating effect of empiric antibiotic, mechanical ventilation, and central venous catheter (CVC)duration on risk-adjusted mortality.
resultsOne hundred forty prompted group and 125 control group patients were included. One hundred eighty-three patients were exposed to at least one day of empiric antibiotics during MICU admission. Hospital mortality increased as empiric antibiotic duration increased (P<0.001). Prompting was associated with shorter empiric antibiotic duration and lower risk-adjusted mortality in patients receiving empiric antibiotics (OR 0.41, 95% CI 0.18-0.92, P=0.032). When empiric antibiotic duration was added to mortality models, the adjusted OR for the intervention was attenuated from 0.41 to 0.50, suggesting that shorter duration of empiric antibiotics explained 15.2% of the overall benefit of prompting. Evaluation of mechanical ventilation was limited by study size. Accounting for CVC duration changed the intervention effect slightly.
conclusionsIn this analysis, some improvement in mortality associated with prompting was explained by shorter empiric antibiotic duration. However, most of the mortality benefit of prompting was unexplained.
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