1227. Analysis of Prescriber Interaction with an Electronic Antibiotic Time-out Best Practice Alert

Abstract

Abstract Background The impact of antibiotic time-outs (ATOs) on antibiotic use relies heavily on prescriber interaction, which may be reduced due to workflow disruption or alert fatigue. In August 2022, Hartford HealthCare implemented a 72-hour ATO best practice alert. Herein, we evaluated prescriber behavior when interacting with the ATO alert to assess the impact on prescriber stewardship workflow. Methods An ATO alert was designed to fire between 0700 and 1630. Upon firing, prescribers were prompted to assess for antibiotic modification – a composite including discontinuation, de-escalation, inclusion of stop-date, and transition to oral therapies. Additional responses were included to defer re-firing for patients deemed not to be a candidate for antibiotic modification. The primary endpoint was defined as the rate of ATO response aligning with antibiotic modification for the 10 most frequently utilized antibiotics and assessed from 10/1/22 – 12/31/22. A predefined subset of patients was evaluated for ATO appropriateness by prescriber specialty and role. Results A total of 15,383 ATO alerts were included for analysis, corresponding to 3,498 unique patients. The primary endpoint occurred in 21.4% of cases. The most commonly selected ATO response was a reminder in 10 minutes (48.2%). The median time viewing the ATO alert was 5 seconds (IQR 4 – 8s). In a subset of 400 patients, ATO selections were found to be appropriate in 56% of cases. When stratified by prescriber role, attending physicians were more likely to appropriately utilize the ATO compared to resident and advanced practice practitioners (62.7% vs 48.5% vs 46.2%, p = 0.007) and were more likely to select an ATO response aligning with antibiotic modification (39.5% vs 7.6% vs 12.3%, p < 0.001). Conclusion ATO selection corresponding to antibiotic modification was low regardless of prescriber role. Further work optimizing the ATO design will be required to improve integration into stewardship workflow. Disclosures Joseph L. Kuti, PharmD, bioMeriuex Inc.: Grant/Research Support|Entasis Therapeutics: Grant/Research Support|Merck & Co, Inc: Grant/Research Support|Shionogi Inc: Advisor/Consultant|Shionogi Inc: Grant/Research Support|Shionogi Inc: Honoraria