Abstract
P-960. Evaluation of a discharge-focused stewardship intervention in a stepped wedge cluster randomized trial across 10 hospitals
Open forum infectious diseases, Vol.13(Supplement_1)
01/11/2026
DOI: 10.1093/ofid/ofaf695.1162
Abstract
Background We evaluated whether an antibiotic stewardship bundle, which included audit-and-feedback, could reduce antibiotic overuse at hospital discharge. Methods We performed a stepped-wedge cluster randomized trial across participating units at 10 hospitals to evaluate the effect of a discharge-focused stewardship bundle. The trial ran from 12/5/22-11/17/23. After a 24-week baseline period, one hospital crossed into the intervention arm every 2 weeks. The intervention consisted of a) disseminating institutional guidelines for oral antibiotic step-down therapy; and b) prospective audit-and-feedback on inpatients receiving antibiotics who had an anticipated discharge in the next 48 hours. The primary outcome was post-discharge antibiotic use. Secondary outcomes included inpatient antibiotic use, length-of-stay, and readmissions. After the intervention ended, providers and stewardship personnel from each hospital were surveyed and interviewed, respectively, to assess acceptability and feasibility. Results There were 21,782 patient-admissions included (14,228 baseline period; 7,554 intervention period). Median age was 66 years, with 61% male (Table 1). At the hospital-level, the average number of patients audited per week was 20; one-quarter of audits led to feedback. There were 3,133 (21.9%) patients prescribed post-discharge antibiotics at baseline compared to 1,645 (21.8%) during the intervention (OR 1.02; 95% CI 0.95-1.09). The mean post-discharge duration was 7.1 days (SD 5.2) at baseline compared to 7.6 days (SD 5.6) during the intervention (RR 1.02; 95% CI 0.98-1.07). Inpatient antibiotic duration was shorter during the intervention (RR 0.91; 95% CI 0.86-0.97), but there was no difference in length-of-stay and readmissions (Table 2). One hundred twelve inpatient providers were sent a post-intervention survey; 40 (35.7%) responded; 94% felt that the initiative improved antibiotic-prescribing at discharge (Table 3). However, many stewardship teams reported difficulty in accurately identifying when patients would be discharged (Table 4). Conclusion An antibiotic stewardship bundle, which included audit-and-feedback, did not reduce antibiotic use at discharge. The bundle was acceptable to providers but difficult for stewardship teams to implement. Disclosures Yvonne Burnett, PharmD, BCIDP, InflaRx: Honoraria|Melinta Therapeutics: Honoraria
Details
- Title: Subtitle
- P-960. Evaluation of a discharge-focused stewardship intervention in a stepped wedge cluster randomized trial across 10 hospitals
- Creators
- Daniel Livorsi - University of IowaAlyssa Thompson - Barnes-Jewish CollegeAngela Hoelscher - Barnes-Jewish CollegeKailye Chu - Barnes-Jewish CollegeElizabeth Neuner - Barnes-Jewish HospitalYvonne Burnett - Saint Louis University HospitalTeri Hopkins - South Texas Veterans Health Care SystemElizabeth Walter - Murphy Oil Corporation (United States)Rohini Dave - VA Maryland Health Care SystemRavi Tripathi - University of Maryland, BaltimoreHaylie Lohmar - Richard L. Roudebush VA Medical CenterAndrew Dysangco - Atlanta VA Medical CenterKelly M Percival - University of IowaDilek Ince - University of Iowa, Infectious DiseasesJessica KolkmeyerHelen Newland - BJC HealthCareJoshua Hendrix - Barnes-Jewish CollegeGosia CloreCody Poe - University of IowaAmy O’Shea - University of Iowa, General Internal MedicineDeShauna Jones - University of IowaEmily E Chasco - University of IowaJoseph Tholany - University of IowaKunatum Prasidthrathsint - University of IowaErin Rachmiel - Washington University in St. LouisJahnavi Bongu - Washington University in St. LouisAlice Bewley - Washington University in St. LouisKevin Hsueh - Washington University in St. Louis
- Resource Type
- Abstract
- Publication Details
- Open forum infectious diseases, Vol.13(Supplement_1)
- DOI
- 10.1093/ofid/ofaf695.1162
- ISSN
- 2328-8957
- eISSN
- 2328-8957
- Publisher
- Oxford University Press
- Language
- English
- Date published
- 01/11/2026
- Academic Unit
- Infectious Diseases; Pathology; Center for Social Science Innovation; Injury Prevention Research Center; Institute for Clinical and Translational Science; General Internal Medicine; Internal Medicine
- Record Identifier
- 9985121598402771
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