Evidence map›Paper›PMID 31296255›Full record

ArticleTrials2019

Antibiotic Review Kit for Hospitals (ARK-Hospital): study protocol for a stepped-wedge cluster-randomised controlled trial.

Ann Sarah Walker, Eric Budgell, Magda Laskawiec-Szkonter, Katy Sivyer, Sarah Wordsworth, Jack Quaddy, Marta Santillo, Adele Krusche, Laurence S J Roope, Nicole Bright and 17 more

Open access · goldAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in Trials, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
2.5field-weighted citation impact, top 12% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 18 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors at 10 institutions in 1 country.

Ann Sarah WalkerNuffield Department of Medicine, University of Oxford, Oxford, UK. sarah.walker@ndm.ox.ac.uk.ORCID http://orcid.org/0000-0002-0412-8509
Eric BudgellNuffield Department of Medicine, University of Oxford, Oxford, UK.
Magda Laskawiec-SzkonterNuffield Department of Medicine, University of Oxford, Oxford, UK.
Katy SivyerCentre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Sarah WordsworthHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Jack QuaddyNuffield Department of Medicine, University of Oxford, Oxford, UK.
Marta SantilloCentre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Adele KruscheCentre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Laurence S J RoopeHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Nicole BrightNuffield Department of Medicine, University of Oxford, Oxford, UK.
Fiona MowbrayCentre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Nicola JonesOxford University Hospitals NHS Foundation Trust, Oxford, UK.
Kieran HandUniversity of Southampton, Southampton, UK.
Najib RahmanNuffield Department of Medicine, University of Oxford, Oxford, UK.
Melissa DobsonNuffield Department of Medicine, University of Oxford, Oxford, UK.
Emma HedleyNuffield Department of Medicine, University of Oxford, Oxford, UK.
Derrick CrookNuffield Department of Medicine, University of Oxford, Oxford, UK.
Mike SharlandSt George's, University of London, London, UK.
Chris RoseveareSouthern Health NHS Foundation Trust, Southampton, UK.
F D Richard HobbsDepartment of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Chris ButlerDepartment of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Louella VaughanThe Nuffield Trust, London, UK.
Susan HopkinsRoyal Free London NHS Foundation Trust, London, UK.
Lucy YardleyCentre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Timothy E A PetoNuffield Department of Medicine, University of Oxford, Oxford, UK.
Martin J LlewelynBrighton and Sussex Medical School, Brighton, UK.
ARK trial team
University of Oxford · GBBrighton and Sussex Medical School · GBRoyal Free London NHS Foundation Trust · GBSt George's, University of London · GBUniversity Hospital Southampton NHS Foundation Trust · GBNuffield Trust · GBOxford University Hospitals NHS Trust · GBSouthern Health NHS Foundation Trust · GBUniversity of Bristol · GBUniversity of Southampton · GB

Funding

Department of Health IS-SPC-0514-10043Department of Health RP-PG-0514-20015Programme Grants for Applied Research RP-PG-0514-20015
6 · The paper itself

Abstract

backgroundTo ensure patients continue to get early access to antibiotics at admission, while also safely reducing antibiotic use in hospitals, one needs to target the continued need for antibiotics as more diagnostic information becomes available. UK Department of Health guidance promotes an initiative called 'Start Smart then Focus': early effective antibiotics followed by active 'review and revision' 24-72 h later. However in 2017, < 10% of antibiotic prescriptions were discontinued at review, despite studies suggesting that 20-30% of prescriptions could be stopped safely. METHODS/

designAntibiotic Review Kit for Hospitals (ARK-Hospital) is a complex 'review and revise' behavioural intervention targeting healthcare professionals involved in antibiotic prescribing or administration in inpatients admitted to acute/general medicine (the largest consumers of non-prophylactic antibiotics in hospitals). The primary study objective is to evaluate whether ARK-Hospital can safely reduce the total antibiotic burden in acute/general medical inpatients by at least 15%. The primary hypotheses are therefore that the introduction of the behavioural intervention will be non-inferior in terms of 30-day mortality post-admission (relative margin 5%) for an acute/general medical inpatient, and superior in terms of defined daily doses of antibiotics per acute/general medical admission (co-primary outcomes). The unit of observation is a hospital organisation, a single hospital or group of hospitals organised with one executive board and governance framework (National Health Service trusts in England; health boards in Northern Ireland, Wales and Scotland). The study comprises a feasibility study in one organisation (phase I), an internal pilot trial in three organisations (phase II) and a cluster (organisation)-randomised stepped-wedge trial (phase III) targeting a minimum of 36 organisations in total. Randomisation will occur over 18 months from November 2017 with a further 12 months follow-up to assess sustainability. The behavioural intervention will be delivered to healthcare professionals involved in antibiotic prescribing or administration in adult inpatients admitted to acute/general medicine. Outcomes will be assessed in adult inpatients admitted to acute/general medicine, collected through routine electronic health records in all patients. DISCUSSION: ARK-Hospital aims to provide a feasible, sustainable and generalisable mechanism for increasing antibiotic stopping in patients who no longer need to receive them at 'review and revise'.

trial registrationISRCTN Current Controlled Trials, ISRCTN12674243 . Registered on 10 April 2017.

Indexed as

Antimicrobial StewardshipAttitude of Health PersonnelHealth Knowledge, Attitudes, PracticeHospitalsInservice TrainingMedication Therapy ManagementAnti-Bacterial AgentsDrug Administration ScheduleDrug PrescriptionsEquivalence Trials as TopicFeasibility StudiesHealth PersonnelHumansMulticenter Studies as TopicPatient AdmissionPilot ProjectsAnti-Bacterial AgentsAntibiotic prescribingAntimicrobial stewardshipHospitals

Identifiers

PMID31296255
PMCPMC6625068
OpenAlexW2949735619

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.