Trial reportCritical care medicine2013
A clinical trial comparing physician prompting with an unprompted automated electronic checklist to reduce empirical antibiotic utilization.
Trial report in Critical care medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
22 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Computer-generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes.The Cochrane database of systematic reviews · 2017Pooled it
- Interventions to improve antibiotic prescribing practices for hospital inpatients.The Cochrane database of systematic reviews · 2017Pooled it
- Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- 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
- The effects of on-screen, point of care computer reminders on processes and outcomes of care.The Cochrane database of systematic reviews · 2009Pooled it
- EMERGE: Early antiMicrobial stEwaRdship for GEneral medicine patients-targeting inpatient intravenous therapy greater than 24 hours.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Implementation of an Automated Antibiotic Time-out at a Comprehensive Cancer Center.Open forum infectious diseases · 2024Article
- Measuring Performance on the ABCDEF Bundle During Interprofessional Rounds via a Nurse-Based Assessment Tool.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2023Article
- Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient Survival: A Controlled Before-and-After Study.Critical care explorations · 2023Article
- Impact of electronic health records on predefined safety outcomes in patients admitted to hospital: a scoping review.BMJ open · 2021Article
- Implementation of a Pharmacist-Led Antimicrobial Time-Out for Medical-Surgery Services in an Academic Pediatric Hospital.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2021Article
- Cognitive bias: how understanding its impact on antibiotic prescribing decisions can help advance antimicrobial stewardship.JAC-antimicrobial resistance · 2020Review
- Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes.Infection control and hospital epidemiology · 2020Article
- Understanding Digital Checklist Use Through Team Communication.Extended abstracts on Human factors in computing systems. CHI Conference · 2020Article
- Educational Strategies for Training in Quality Improvement and Implementation Medicine.ATS scholar · 2020Article
- Review
- Exploring the nurses' role in antibiotic stewardship: A multisite qualitative study of nurses and infection preventionists.American journal of infection control · 2018Article
- Antibiotic Stewardship Programs in U.S. Acute Care Hospitals: Findings From the 2014 National Healthcare Safety Network Annual Hospital Survey.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Article
- Antibiotic stewardship in the intensive care unit.Critical care (London, England) · 2014Review
- Influence of an infectious diseases specialist on ICU multidisciplinary rounds.Critical care research and practice · 2014Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
objectivesTo determine whether face-to-face prompting of critical care physicians reduces empirical antibiotic utilization compared to an unprompted electronic checklist embedded within the electronic health record.
designRandom allocation design.
settingMedical ICU with high-intensity intensivist coverage at a tertiary care urban medical center. PATIENTS: Two hundred ninety-six critically ill patients treated with at least 1 day of empirical antibiotics.
interventionsFor one medical ICU team, face-to-face prompting of critical care physicians if they did not address empirical antibiotic utilization during a patient's daily rounds. On a separate medical ICU team, attendings and fellows were trained once to complete an electronic health record-embedded checklist daily for each patient, including a question asking whether listed empirical antibiotics could be discontinued. MEASUREMENTS AND MAIN
resultsPrompting led to a more than four-fold increase in discontinuing or narrowing of empirical antibiotics compared to use of the electronic checklist. Prompted group patients had a lower proportion of patient-days on which empirical antibiotics were administered compared to electronic checklist group patients (63.1% vs 70.0%, p = 0.002). Mean proportion of antibiotic-days on which empirical antibiotics were used was also lower in the prompted group, although not statistically significant (0.78 [0.27] vs 0.83 [0.27], p = 0.093). Each additional day of empirical antibiotics predicted higher risk-adjusted mortality (odds ratio, 1.14; 95% CI, 1.05-1.23). Risk-adjusted ICU length of stay and hospital mortality were not significantly different between the two groups.
conclusionsFace-to-face prompting was superior to an unprompted electronic health record-based checklist at reducing empirical antibiotic utilization. Sustained culture change may have contributed to the electronic checklist having similar empirical antibiotic utilization to a prompted group in the same medical ICU 2 years prior. Future studies should investigate the integration of an automated prompting mechanism with a more generalizable electronic health record-based checklist.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.