Improved antibiotic prescribing using indication‐based clinical decision support in the emergency department

BACKGROUND: Evaluate an indication‐based clinical decision support tool to improve antibiotic prescribing in the emergency department. METHODS: Encounters where an antibiotic was prescribed between January 2015 and October 2017 were analyzed before and after the introduction of a clinical decision support tool to improve clinicians’ selection of a guideline‐approved antibiotic based on clinical indication. Evaluation was conducted on a pre‐defined subset of conditions that included skin and soft tissue infections, respiratory infections, and urinary infections. The primary outcome was ordering of a guideline‐approved antibiotic prescription at the drug and duration of therapy level. A mixed model following a binomial distribution with a logit link was used to model the difference in proportions of guideline‐approved prescriptions before and after the intervention. RESULTS: For conditions evaluated, selection rate of a guideline‐approved antibiotic for a given indication improved from 67.1% to 72.2% (P < 0.001). When duration of therapy is included as a criterion, selection of a guideline‐approved antibiotic was lower and improved from 24.7% to 31.4% (P < 0.001), highlighting that duration of therapy is often missing at the time of prescribing. The most substantial improvements were seen for pneumonia and pyelonephritis with an increase from 87.9% to 97.5% and 62.8% to 82.6%, respectively. Other significant improvements were seen for abscess, cellulitis, and urinary tract infections. CONCLUSION: Antibiotic prescribing can be improved both at the drug and duration of therapy level using a non‐interruptive and indication based‐clinical decision support approach. Future research and quality improvement efforts are needed to incorporate duration of therapy guidelines into the antibiotic prescribing process.