Evaluation of Antibiotic Selection in the Emergency Department Following the Implementation of an Infectious Source-Specific Order Set

Abstract

Emergency department (ED) practitioners frequently prescribe antibiotics for sepsis and other infections, with quality and performance metrics often influencing broad-spectrum antibiotic selection. This study objective was to evaluate improvements in antibiotic selection in the ED following implementation and revision of sepsis order sets designed to adhere to Centers for Medicare and Medicaid Services sepsis performance measure bundle across time periods. This single-center, retrospective analysis assessed antibiotic orders in the ED across three periods of order set availability: no sepsis order set (period 1), general broad-spectrum order set (period 2), and infectious-source specific order set (period 3). Order rates of narrow-spectrum β-lactams, extended-spectrum cephalosporins, antipseudomonal β-lactams, fluoroquinolones, clindamycin, and other agents were assessed. Individual patient encounters with antibiotic orders for period 1 (n = 4228), period 2 (n = 4407), and period 3 (n = 5129) were assessed. Order set use for antibiotic ordering increased across time periods (4% vs 20.6% vs 53.3%; P < 0.001). Period 3 was associated with an increase in narrow spectrum β-lactam use (3% vs 3% vs 15.2%; P < 0.001), a decrease in antipseudomonal β-lactam use (30.1% vs 36.1% vs 27.7%; P < 0.001), and a decrease in targeted antibiotics associated with high risk for adverse effects (28% vs 16% vs 6.9%; P < 0.001). The creation and utilization of an infectious source-specific sepsis antibiotic order set was associated with improved antibiotic ordering trends in the emergency department. This intervention should be considered by hospital antimicrobial stewardship programs.