title: Prospective multicentre feasibility study of a quality of care indicator for intravenous to oral switch therapy with highly bioavailable antibiotics.
abstract: BACKGROUND
  Enhanced oral (po) bioavailability of antimicrobial drugs allows conversion to po therapy once a patient meets defined clinical criteria. This can reduce length of hospital stay, healthcare costs and risk of complications related to intravenous (iv) access. We developed a quality indicator for assessing the appropriate iv-to-po switch of bioavailable antibiotics and evaluated its feasibility and clinical relevance across acute healthcare systems.
  
  
  METHODS
  The study was designed as a multicentre, multinational observational audit. The indicator was the proportion of inappropriate iv treatments at any point in time in adult patients treated with fluoroquinolones, clindamycin, linezolid or metronidazole. Treatments were prospectively evaluated by a trained physician or clinical pharmacist using predefined clinical criteria. The feasibility of the indicator was evaluated by measuring data availability, data collection workload and sensitivity to improvement
  
  
  RESULTS
  Data were collected over a 3 month period in five university hospitals in Austria, Belgium and Germany and iv treatment was assessed in 211 patients. The indicator was measurable in 99.1% of cases. By intention-to-treat analysis, 37.0% (95% CI 30.5-43.9) of treatments were inappropriate, ranging from 17.5% to 53.8% across hospitals. The median time needed for case assessment and documentation was 29 min.
  
  
  CONCLUSIONS
  This quality indicator was found to be generally feasible in hospitals across three European countries, and informative about the local need for clinical quality improvement.
authors.affiliation: Pharmacy Department, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. franky.buyle@uzgent.be
authors.forename: F M
authors.initials: FM
authors.lastname: Buyle
authors.forename: S
authors.initials: S
authors.lastname: Metz-Gercek
authors.forename: R
authors.initials: R
authors.lastname: Mechtler
authors.forename: W V
authors.initials: WV
authors.lastname: Kern
authors.forename: H
authors.initials: H
authors.lastname: Robays
authors.forename: D
authors.initials: D
authors.lastname: Vogelaers
authors.forename: M J
authors.initials: MJ
authors.lastname: Struelens
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001317:Austria; D001424:Bacterial Infections / Q000188:drug therapy*; D001530:Belgium; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D007262:Infusions, Intravenous; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents