228. Impact of Early Alert to Antimicrobial Stewardship Interventions with the Prospective Audit and Feedback Strategy

BACKGROUND: Prospective audit-feedback is the primary strategy adopted by our hospital antibiotic stewardship program (ASP). It is labor-intensive and successful uptake relies on the visibility of the written intervention note. A rapid notification system (RNS), whereby the physical note is replaced by an electronic document followed by immediate prescriber alert through text messaging, was recently implemented. We seek to quantify the impact of this initiative on patient outcomes and ASP resource utilization. METHODS: Interventions to discontinue, de-escalate, or switch from intravenous to oral antibiotics in the pre-implementation (P1: January 2016–February 2017) and post-implementation (P2: March 2017–February 2018) periods were identified from the ASP database. Same-day intervention acceptance rate (IAR), duration of antibiotic therapy (DOT), and hospital length of stay (LOS), measured from day of intervention to discharge, were compared. Manpower time saved from having to perform a next-day intervention follow-up (15 minutes/intervention) was calculated. RESULTS: A total of 1,904 (11.4%) and 1,311 (12.4%) interventions of 16,723 and 10,545 antibiotic audits were made during P1 and P2, respectively. There were no significant differences in antibiotic or intervention types between both periods–piperacillin–tazobactam (85.4%) was most common, followed by meropenem (11.4%); intervention to discontinue antibiotic (68.4%) was most frequent. Implementation of RNS led to a pronounced 2.5-fold increase in same-day IAR (19.3% vs. 47%, P < 0.01). Potential savings in ASP manpower was estimated at 75 hours/year. Overall improvement in IAR at 48-hours was also observed (79.2% vs. 82.5%, P = 0.02). Patients with ASP interventions accepted on the same day had significantly shorter DOT (4.4 vs. 5.4 days, P < 0.01) but not LOS (13.4 vs. 11.6 days, P = 0.08). Thirty-day-day infection-related mortality rates were similar across the two periods (3.3% vs. 3.3%). CONCLUSION: An early alert to ASP interventions can strengthen the impact of ASP in reducing unnecessary antibiotic use without compromise in patient safety. ASPs, particularly those serving large and busy hospitals, should consider having an RNS in place to improve program efficiency and visibility. DISCLOSURES: All authors: No reported disclosures.