Improving antimicrobial use in the hospital setting by providing usage feedback to prescribing physicians.
OBJECTIVE
To determine whether feedback on antimicrobial use improves physician compliance with local hospital guidelines on antimicrobial prescribing.


METHODS
In this time series analysis, in which a historical control period was compared with an intervention period, all orders for antimicrobials (except those for surgical prophylaxis) placed from November 1, 2002, through April 30, 2004, were prospectively evaluated by an antimicrobial management team (AMT) for compliance with local hospital guidelines. During the control period, orders were evaluated to determine compliance with hospital guidelines before and after recommendations by the AMT were provided to physicians. Feedback was given for the second 9-month period in the form of a weekly report to prescribing physicians, a monthly hospital newsletter, and a quarterly report to various hospital committees. During the intervention period, orders were evaluated to determine compliance with hospital guidelines before and after recommendations by the AMT were provided to physicians.


METHODS
The Veterans Affairs Medical Center, a 110-bed facility, in Louisville, Kentucky.


METHODS
Internal medicine physicians and general surgeons.


RESULTS
A total of 2,807 antimicrobial courses were evaluated. Compliance with hospital guidelines before AMT recommendations was 70% during the control period and 74% during the intervention period (P=.02). Compliance after AMT recommendations was 90% during the control period and 93% during the intervention period (P< or =.01).


CONCLUSIONS
The use of feedback had a significantly favorable impact on physician compliance with the hospital's guidelines on antimicrobial prescribing. Use of feedback should be added to the list of interventions that promote appropriate antimicrobial use in the hospital setting.
Arnold
Forest W
FW
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, 512 South Hancock Street, Louisville, KY 40292, USA. F.Arnold@louisville.edu
McDonald
L Clifford
LC
Smith
R Scott
RS
Newman
David
D
Ramirez
Julio A
JA
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review; D005246:Feedback; D013502:General Surgery / Q000193:education; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007629:Kentucky; D008485:Medical Audit; D016106:Methicillin Resistance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects; D013995:Time; D014481:United States; D014493:United States Department of Veterans Affairs
D000900:Anti-Bacterial Agents