title: Earlier switching from intravenous to oral antibiotics owing to electronic reminders.
abstract: Paper-based interventions have been shown to stimulate switching from intravenous (i.v.) to oral (p.o.) antibiotic therapies. Shorter i.v. durations are associated with a lower risk of iatrogenic infections as well as reduced workload and costs. The purpose of this study was to determine whether automated electronic reminders are able to promote earlier switching. In this controlled before-and-after study, an algorithm identified patients who were eligible for i.v.-to-p.o. switch 60 h after starting i.v. antimicrobials. Reminders offering guidance on the re-assessment of initial i.v. therapy were displayed within the electronic health records in 12 units during the intervention period (year 2012). In contrast, no reminders were visible during the baseline period (2011) and in the control group (17 units). A total of 22863 i.v. antibiotic therapies were analysed; 6082 (26.6%) were switched to p.o.
  
  
  METHODS
  In the intervention group, 757 courses of i.v. antibiotics were administered for a mean ± standard deviation duration of 5.4 ± 8.1 days before switching to p.o. antibiotics in the baseline period, and 794 courses for 4.5 ± 5.5 days in the intervention period (P = 0.004), corresponding to a 17.5% reduction of i.v. administration time. In contrast, in the control group the duration increased; 2240 i.v. antibiotics were administered for a mean duration of 4.0 ± 5.9 days in the baseline period, and 2291 for 4.3 ± 5.8 days in the intervention period (P = 0.03). Electronic reminders fostered earlier i.v.-to-p.o. switches, thereby reducing the duration of initial i.v. therapies by nearly a day.
authors: Research Center for Medical Informatics, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors: Patrick E
authors: PE
authors: Beeler
authors: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors: Stefan P
authors: SP
authors: Kuster
authors: Research Center for Medical Informatics, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors: Emmanuel
authors: E
authors: Eschmann
authors: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors: Rainer
authors: R
authors: Weber
authors: Research Center for Medical Informatics, University Hospital Zurich and University of Zurich, Zurich, Switzerland. Electronic address: juerg.blaser@usz.ch.
authors: Jürg
authors: J
authors: Blaser
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D065187:Controlled Before-After Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017010:Reminder Systems; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Anti-infective agents/administration & dosage; Antibacterial agents; Decision support systems, clinical; Medical informatics, reminder systems