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EDs should tailor clinical decision support to avoid antibiotic overprescribing, data suggests

Systems are rarely tailored to the context of the ED environment and end user needs, findings showed.

Jeff Lagasse, Associate Editor

A unique set of factors of the emergency department makes standard Clinical Decision Support (CDS) systems not as effective in helping to reduce antibiotic overprescribing in that environment, according to findings from the University of Colorado College of Nursing at the Anschutz Medical Campus.

Antimicrobial resistance is a major public health concern, accounting for 2.8 million infections and 35,000 deaths annually. Hospitals have focused on antibiotic stewardship programs (ASP) to reduce overprescribing of antibiotics, which is a major contributor to antimicrobial resistance. 

While this has been effective in reducing unnecessary antibiotic use by as much as 36% in inpatient settings, EDs are an exception, where approximately 10 million outpatient antibiotic prescriptions are written annually in the U.S. Data shows that up to 50% of the prescriptions were inappropriate or unnecessary.

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WHAT'S THE IMPACT?

The study, published in Applied Clinical Informatics, looked at three pediatric EDs to determine how the unique setting of the ED influences this pattern, and how CDS systems can complement professional judgment in the ED setting and potentially reduce unnecessary antibiotic use. 

The ED, it turns out, is unique, with several factors at play: clinical judgment, provider fatigue, the busyness of the ED, workflow, technology, bed availability, and social determinants of health of the patient and their families, which all impact antibiotic prescribing decisions.

The study of 38 ED providers analyzed these and additional factors to determine how to design a CDS system to assist with antimicrobial stewardship in pediatric emergency departments. It discovered that systems are rarely tailored to the context of the ED environment and end user needs.

ED clinicians often are required to make rapid decisions and are interrupted frequently during the decision-making process, and current CDS systems don't take this unique set of circumstances into account, findings showed. 

That means there are opportunities to improve the appropriateness of antibiotic prescribing in these settings, such as including contextual data, considering the current limitations of current CDS systems, and tailoring the design and implementation, which all could help in reducing unnecessary antibiotic use.

THE LARGER TREND

Hospital emergency departments are seeing steep declines in the numbers of patients they're treating, and April was an especially rough month. In fact, from April to 2019 to April 2020 there was a 42% decline in emergency department visits, according to June data published in the Morbidity and Mortality Weekly Report from the U.S. Centers for Disease Control and Prevention.

That's had a direct impact on hospital finances, since facilities have lost millions in ED revenue at a time when many are still treating high numbers of COVID-19 patients.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com