Validation of quality indicators for hospital antibiotic use by the ABS International Quality Indicators (QI) Project
Abstract number: O296
Struelens M., Metz-Gercek S., Mechtler R., Buyle F., Lechner A., Mittermayer H., Allerberger F., Kern W.
Objectives: The EU-Project Antibiotic Strategy International (ABS) QI team developed process QIs for auditing the performance of key treatment and prophylactic practices. An international network of pilot hospitals tested these tools for feasibility, reliability and sensitivity to improvement.
Methods: QIs included:
1surgical prophylaxis (indication, drug choice, timing and duration of administration);
2management of community-acquired pneumonia (CAP) (blood culture and Legionella antigen tests and drug choice for empirical treatment);
3management of S. aureus bacteraemia (echocardiography, IV catheter removal and duration of therapy); and
4iv-po switch for bio-available antibiotics.
A minimum of 40 consecutive cases per centre and QI were retrospectively reviewed from clinical, laboratory and administrative records and assessed for data availability, inter-observer reliability, data collection workload and performance score.
Results: A total of 1240 patients were evaluated in 11 acute care hospitals from 5 countries, with a range of 80 to 500 cases and 2 to 9 centres per indicator. Seven centres had already implemented antibiotic quality improvement and audit programmes. Availability of data was >85% of cases and ranged between 87% (catheter removal in S. aureus bacteraemia) and 100% (diagnostic tests for CAP). 13/14 indicators were found to be reliable with kappa 0.60 (good to excellent agreement). The workload per case ranged from a median time of 16 (CAP) to 35 min (iv-po switch). The intention to treat QI scores showed high levels of adherence to the surgical prophylaxis QI bundle, with median values of 81 to 97% for hip prosthesis and 65 to 92% for colo-rectal surgery. For CAP management, diagnostic testing appeared sub-optimal (<56% compliance with IDSA guidelines). For S. aureus bacteraemia management, indicator results ranged from 60 to 65%. For use of bio available antibiotics, a median of 45% iv administrations were avoidable. There were marked differences of scores between centres for all QIs.
Conclusions: The ABS QIs are reliable and broadly applicable tools for auditing antibiotic treatment and prophylactic practices. Inter-hospital variation in adherence to recommended practice indicates substantial potential for improvement with different local priorities. These QIs can be recommended for assessing the effect of quality of care interventions at either local or multi-centre level.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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