National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Ambulatory Care and Surgery (1)
- (-) Antibiotics (9)
- Antimicrobial Stewardship (1)
- Children/Adolescents (2)
- Clinical Decision Support (CDS) (2)
- Community-Acquired Infections (1)
- (-) Emergency Department (9)
- Guidelines (1)
- Health Information Technology (HIT) (2)
- Infectious Diseases (1)
- Inpatient Care (1)
- Medication (6)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Patient Safety (1)
- Pneumonia (1)
- Practice Patterns (1)
- Primary Care (1)
- Provider (1)
- Provider: Pharmacist (1)
- Provider: Physician (1)
- Respiratory Conditions (1)
- Sepsis (3)
- Skin Conditions (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 9 of 9 Research Studies DisplayedLee AH, McEvoy DS, Stump T
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
This study analyzed the influence of clinical decision support (CDS) to prevent delays in second doses of broad-spectrum antibiotics in the emergency department (ED). The authors allocated adult patients who received cefepime or piperacillin/tazobactam in 9 EDs within an integrated health care system to an electronic alert that reminded ED clinicians to reorder antibiotics at the appropriate interval vs usual care. Primary outcome was a median delay in antibiotic administration, and secondary outcomes were rates of intensive care unit (ICU) admission, hospital mortality, and hospital length of stay. A total of 1,113 ED patients treated with cefepime or piperacillin/tazobactam were enrolled in the study, of whom 420 remained under ED care when their second dose was due. The electronic alert system was associated with reduced antibiotic delays, but there were no differences in ICU transfers, inpatient mortality, or hospital length of stay.
AHRQ-funded; HS027170.
Citation: Lee AH, McEvoy DS, Stump T .
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
Ann Emerg Med 2023 Apr;81(4):485-91. doi: 10.1016/j.annemergmed.2022.10.022.
Keywords: Antibiotics, Medication, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT)
Dutta S, McEvoy DS, Rubins DM
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
This paper discusses the outcomes of using a clinical decision support (CDS) tool that was implemented in emergency departments (EDs) for sepsis patients to remind healthcare staff to take blood cultures before administration of intravenous (IV) antibiotics. The study compared timely blood culture collection outcomes prior to IV antibiotics for 54,538 adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. The baseline phase found that 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. The CDS improved blood culture collection rates without increasing overutilization.
AHRQ-funded; HS02717.
Citation: Dutta S, McEvoy DS, Rubins DM .
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
J Am Med Inform Assoc 2022 Sep 12;29(10):1705-14. doi: 10.1093/jamia/ocac115..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Antibiotics, Emergency Department, Medication, Sepsis
Fritz SA, Shapiro DJ, Hersh AL
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
This study looked at national trends in the incidence of outpatient visits for skin infections from 2000-2015, which peaked in 2010-2013, followed by a plateau in 2014 and 2015. Cephalexin was the most frequently prescribed antibiotic at the beginning of the study, with trimethoprim-sulfamethoxazole then becoming the most frequently prescribed by the end of the study period.
AHRQ-funded; HS021736; HS024269.
Citation: Fritz SA, Shapiro DJ, Hersh AL .
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
Clin Infect Dis 2020 Jun 10;70(12):2715-18. doi: 10.1093/cid/ciz977..
Keywords: Skin Conditions, Ambulatory Care and Surgery, Emergency Department, Antibiotics, Medication
Baxa J, McCreary E, Schulz L
Finding the niche: an interprofessional approach to defining oritavancin use criteria in the emergency department.
This study’s purpose was to identify a population of emergency department (ED) patients with cellulitis who would be the most appropriate to receive oritavancin which is a novel, broad-spectrum antibiotic. This antibiotic is given in one dose for the entire treatment course. A retrospective cohort study of cellulitis patients was conducted at a Midwest healthcare system with 2 EDs. All adult patients admitted from the ED to an inpatient ward were reviewed over a 1-year period. Potentially avoidable admissions (PAAs) were identified and characterized. Out of 86 patients, nine were deemed a PAA. The majority had at last one risk factor for treatment failure (55% with diabetes mellitus) and they were significantly younger than the non-PAA group. In other respects there was no difference between the two groups for non-age demographics and other risk factors or length of stay.
AHRQ-funded; HS024342.
Citation: Baxa J, McCreary E, Schulz L .
Finding the niche: an interprofessional approach to defining oritavancin use criteria in the emergency department.
Am J Emerg Med 2020 Feb;38(2):321-24. doi: 10.1016/j.ajem.2019.158442..
Keywords: Emergency Department, Skin Conditions, Antibiotics, Medication
Trent SA, Havranek EP, Ginde AA
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
This study examined the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for patients with severe sepsis. A quasi-experiment was conducted with attending physicians randomized into 6 clusters at a single urban safety net hospital. Feedback with blinded peer comparison significantly improved guideline adherence from 52% to 65% with feedback.
AHRQ-funded; HS022400.
Citation: Trent SA, Havranek EP, Ginde AA .
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
Am J Med Qual 2019 May/Jun;34(3):217-25. doi: 10.1177/1062860618796947..
Keywords: Antibiotics, Emergency Department, Guidelines, Infectious Diseases, Inpatient Care, Medication, Pneumonia, Provider, Provider: Physician, Sepsis
Mistry RD, May LS, Pulia MS
Improving antimicrobial stewardship in pediatric emergency care: a pathway forward.
In this commentary, the authors discuss a study in this same issue. Recent multidisciplinary teams have used novel methods to successfully engage with and intervene in urgent care, pediatric, and general–emergency department antibiotic prescribing. Antibiotic stewardship programs are recommended, as well as emergency department experts continuing to collaborate and formulate thoughtful solutions to this important patient-safety and public-health issue.
AHRQ-funded; HS024342.
Citation: Mistry RD, May LS, Pulia MS .
Improving antimicrobial stewardship in pediatric emergency care: a pathway forward.
Pediatrics 2019 Feb;143(2). doi: 10.1542/peds.2018-2972..
Keywords: Antimicrobial Stewardship, Antibiotics, Children/Adolescents, Emergency Department, Medication, Patient Safety
Hume PS, Varon J, Englert JA
Trends in "usual care" for septic shock.
The investigators examined changes in treatment patterns for septic shock in the emergency department (ED) of a large academic hospital. The investigators observed, from 2003 to 2013, significant reductions in time to antibiotics and fluids for patients with septic shock in the ED, underscoring the evolution of “usual care” over time. These findings may explain why early goal-directed therapy is not beneficial in the current era and may help inform ongoing deliberations regarding best practices for sepsis care.
AHRQ-funded; HS025008.
Citation: Hume PS, Varon J, Englert JA .
Trends in "usual care" for septic shock.
Infect Control Hosp Epidemiol 2018 Sep;39(9):1125-26. doi: 10.1017/ice.2018.154..
Keywords: Antibiotics, Emergency Department, Practice Patterns, Sepsis
Immergluck LC, Jain S, Ray SM
Risk of skin and soft tissue infections among children found to be staphylococcus aureus MRSA USA300 carriers.
The purpose of this study conducted in a pediatric emergency department was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated specifically with MRSA USA300. It found that children younger than two years were at highest risk for MRSA USA300 carriage. Lower income, recent antibiotic use, and previous or family history of skin and soft tissue infections were risk factors for MRSA USA300 carriage.
AHRQ-funded; HS024338.
Citation: Immergluck LC, Jain S, Ray SM .
Risk of skin and soft tissue infections among children found to be staphylococcus aureus MRSA USA300 carriers.
West J Emerg Med 2017 Feb;18(2):201-12. doi: 10.5811/westjem.2016.10.30483.
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Keywords: Antibiotics, Children/Adolescents, Community-Acquired Infections, Emergency Department, Methicillin-Resistant Staphylococcus aureus (MRSA)
Mehrotra A, Gidengil CA, Setodji CM
Antibiotic prescribing for respiratory infections at retail clinics, physician practices, and emergency departments.
The authors compared antibiotic prescribing among retail clinics, primary care practices, and emergency departments (EDs) for acute respiratory infections (ARIs): antibiotics-may-be-appropriate ARIs and antibiotics-never-appropriate ARIs. They found that, compared with primary care practices and EDs, there was no difference at retail clinics in overall ARI antibiotic prescribing, which was more diagnosis-appropriate.
AHRQ-funded; HS018419.
Citation: Mehrotra A, Gidengil CA, Setodji CM .
Antibiotic prescribing for respiratory infections at retail clinics, physician practices, and emergency departments.
Am J Manag Care 2015 Apr;21(4):294-302.
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Keywords: Antibiotics, Emergency Department, Provider: Pharmacist, Primary Care, Respiratory Conditions