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An Evaluation of Patient Safety and Economic Outcomes

Gilles L. Fraser, PharmD; Patricia Stogsdill, MD; John D. Dickens, Jr; David E. Wennberg, MPH, MD; Robert P. Smith, Jr, MD; B. Stephen Prato, MA

Arch Intern Med. 1997;157(15):1689-1694.

Abstract
Background
Although numerous reports have described interventions designed to influence antibiotic utilization, to our knowledge none have been evaluated in a randomized study.

Methods
Adult inpatients receiving 1 or more of 10 designated parenteral antibiotics for 3 or more days during a 3-month period were randomized to an intervention (n=141) and a control (n=111) group using an unblocked, computer-generated random number table. Obstetric patients and those seen in infectious disease consultation were excluded. The intervention group received antibiotic-related suggestions from a team consisting of an infectious disease fellow and a clinical pharmacist. Both groups were evaluated for clinical and microbiological outcomes as well as antibiotic utilization via prospective chart reviews and analysis of the hospital's administrative database.

Results
Sixty-two (49%) of the intervention group patients received a total of 74 suggestions. Sixty-three (84%) of these suggestions were implemented; the majority involved changes in antibiotic choice, dosing regimen, or route of administration. Per patient antibiotic charges were nearly $400 less in the intervention group vs controls (P=.05). Almost all the savings were related to lower intravenous antibiotic charges. Clinical and microbiological response, antibiotic-associated toxic effects, in-hospital mortality, and readmission rates were similar for both groups. Multiple linear regression analysis identified randomization to the intervention group and female sex as the sole predictors of lower antibiotic charges. There was a trend toward a shorter length of stay for the intervention group (20 vs 24.7 days, P=.11).

Conclusions
This is the first randomized study to evaluate whether antibiotic choices can be influenced in a cost-effective fashion without sacrificing patient safety. We demonstrate that 50% of patients initially treated with expensive parenteral antibiotics can have their regimens refined after 3 days of therapy and that these modifications result in good clinical outcomes with a substantial reduction in antibiotic expense.

Arch Intern Med. 1997;157:1689-1694

Author Affiliations
From the University of Vermont College of Medicine, Burlington (Drs Fraser, Stogsdill, and Smith), and Critical Care Medicine (Dr Fraser and Mr Prato), Infectious Disease Division (Drs Stogsdill and Smith), and Division of Health Services Research (Mr Dickens and Dr Wennberg), Maine Medical Center, Portland.

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