Guideline Adherence
Does an in situ electronic alert warning about discordant antibiotic prescribing safely improve guideline compliance?
Inglés-Guidelines: This is the first of the three layers of the Inglés studies. It focuses on using electronic alerts in the antibiotic prescribing workflow to improve guideline compliance. It both tests the efficacy of the alerting mechanism on clinician behaviour and patient outcomes as well as provides the trial scaffolding for the resistance (information) and estimated (predicted) susceptibility studies.
PICOT
Population
Patients presenting from the community to UCLH and assessed in urgent and ambulatory settings (e.g., A&E/Emergency Department, ambulatory emergency care, urgent outpatient settings) for whom a clinician initiates an antibiotic prescription for suspected or confirmed urinary tract infection (UTI).
Intervention
An EHR-embedded, in-workflow order validation check runs at the time of prescribing and assesses concordance of the intended antibiotic regimen with the current UCLH approved UTI antibiotic guideline.
Guideline-concordant prescription: no action (no alert displayed).
Guideline-discordant prescription: an advisory electronic alert is displayed indicating “off-guideline” prescribing and providing a direct link to the current UCLH UTI guideline. The clinician may dismiss/override the alert and proceed with the original prescription.
Comparator
Usual care with no alert, irrespective of guideline concordance.
Outcomes
Primary outcome
Improvement in guideline-concordant empiric antibiotic prescribing for UTI, expressed as the proportion of eligible prescribing episodes that are guideline-concordant (target improvement from (X%) to (Y%)).
Secondary outcomes
Stewardship outcomes
Reduced prescribing of “Watch” or “Reserve” antibiotics (where applicable).
Reduced use of intravenous (IV) antibiotics when an oral guideline-concordant option is appropriate.
Balancing/safety outcomes
Increase in abandoned/cancelled antibiotic orders without an alternative antibiotic subsequently prescribed within a prespecified time window
No increase in hospital length of stay (for admitted patients)
No increase in re-attendance / re-admission rates among patients treated as outpatients (within a pre-specified follow-up period).
Time
Participants will be followed-up for 7 days
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