Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class Concordance
Introduction: We aimed to assess antibiotic stewardship by quantifying the use of first-dose intravenous (IV) vs oral-only antibiotics and the frequency with which antibiotic class was changed for discharged patients. Secondary aims included the following: evaluation of the relative length of stay (...
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eScholarship Publishing, University of California
2024-09-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/59f190hr |
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| author | Megan Elli Timothy Molinarolo Aidan Mullan Laura Walker |
| author_facet | Megan Elli Timothy Molinarolo Aidan Mullan Laura Walker |
| author_sort | Megan Elli |
| collection | DOAJ |
| description | Introduction: We aimed to assess antibiotic stewardship by quantifying the use of first-dose intravenous (IV) vs oral-only antibiotics and the frequency with which antibiotic class was changed for discharged patients. Secondary aims included the following: evaluation of the relative length of stay (LOS); differences in prescribing patterns between clinician types; differences between academic and community settings; assessment of prescribing patterns among emergency department (ED) diagnoses; and frequency of return visits for patients in each group. Methods: This was a retrospective cohort study including patients presenting to EDs with infections who were discharged from our Midwest healthcare system consisting of 17 community hospitals and one academic center. We included infection type, antibiotic class and route of administration, type of infection, LOS, return visit within two weeks, clinician type, and demographics. Data were collected between June 1, 2018–December 31, 2021 and analyzed using descriptive statistics. Results: We had 77,204 ED visits for patients with infections during the study period, of whom 3,812 received IV antibiotics during their visit. There were more women (62.4%) than men included. Of the 3,812 patients who received IV antibiotics, 1,026 (34.3%) were discharged on a different class of antibiotics than they received. The most common changes were from IV cephalosporin to oral quinolone or penicillin. Patients treated with IV antibiotics prior to discharge had a longer LOS in the ED (median difference of 102 minutes longer for those who received IV antibiotics). There was not a significant difference in the use of IV antibiotics between the academic center and community sites included in the study. Conclusion: Administering IV antibiotics as a first dose prior to oral prescriptions upon discharge is common, as is shifting classes from the IV dose to the oral prescription. This offers an opportunity for intervention to improve antibiotic stewardship for ED patients as well as reduce cost and length of stay. |
| format | Article |
| id | doaj-art-b111705f887a430faf7fe19f5d5d22fa |
| institution | OA Journals |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-b111705f887a430faf7fe19f5d5d22fa2025-08-20T02:38:52ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182024-09-0125696697410.5811/westjem.1799817998Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class ConcordanceMegan Elli0Timothy Molinarolo1Aidan Mullan2Laura Walker3Mayo Clinic, Department of Emergency Medicine, Rochester, MinnesotaMayo Clinic, Department of Emergency Medicine, Rochester, MinnesotaMayo Clinic, Department of Quantitative Health Sciences, Rochester, MinnesotaMayo Clinic, Department of Emergency Medicine, Rochester, MinnesotaIntroduction: We aimed to assess antibiotic stewardship by quantifying the use of first-dose intravenous (IV) vs oral-only antibiotics and the frequency with which antibiotic class was changed for discharged patients. Secondary aims included the following: evaluation of the relative length of stay (LOS); differences in prescribing patterns between clinician types; differences between academic and community settings; assessment of prescribing patterns among emergency department (ED) diagnoses; and frequency of return visits for patients in each group. Methods: This was a retrospective cohort study including patients presenting to EDs with infections who were discharged from our Midwest healthcare system consisting of 17 community hospitals and one academic center. We included infection type, antibiotic class and route of administration, type of infection, LOS, return visit within two weeks, clinician type, and demographics. Data were collected between June 1, 2018–December 31, 2021 and analyzed using descriptive statistics. Results: We had 77,204 ED visits for patients with infections during the study period, of whom 3,812 received IV antibiotics during their visit. There were more women (62.4%) than men included. Of the 3,812 patients who received IV antibiotics, 1,026 (34.3%) were discharged on a different class of antibiotics than they received. The most common changes were from IV cephalosporin to oral quinolone or penicillin. Patients treated with IV antibiotics prior to discharge had a longer LOS in the ED (median difference of 102 minutes longer for those who received IV antibiotics). There was not a significant difference in the use of IV antibiotics between the academic center and community sites included in the study. Conclusion: Administering IV antibiotics as a first dose prior to oral prescriptions upon discharge is common, as is shifting classes from the IV dose to the oral prescription. This offers an opportunity for intervention to improve antibiotic stewardship for ED patients as well as reduce cost and length of stay.https://escholarship.org/uc/item/59f190hr |
| spellingShingle | Megan Elli Timothy Molinarolo Aidan Mullan Laura Walker Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class Concordance Western Journal of Emergency Medicine |
| title | Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class Concordance |
| title_full | Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class Concordance |
| title_fullStr | Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class Concordance |
| title_full_unstemmed | Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class Concordance |
| title_short | Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class Concordance |
| title_sort | use of parenteral antibiotics in emergency departments practice patterns and class concordance |
| url | https://escholarship.org/uc/item/59f190hr |
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