“Time-Outs” To Assess Antibiotics Reduce Both Antibiotics Use and Costs

MedicalResearch.com Interview with:
Consultant in Internal Medicine and Infectious Diseases
Assistant Professor of Medicine, McGill University
Director, General Internal Medicine Consultation Service,
Chief of Service, 6 Medical Clinical Teaching Unit,
McGill University Health Centre

Medical Research: What is the background for this study? What are the main findings?

Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs.  Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use.  Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy.  Sometimes this means that no antibiotics should be given.

In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions.

Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform “antimicrobial self-stewardship”.  This concept tied the CDCs concept of antibiotic “time outs” (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist.  These audits were performed by our senior resident physicians in the context of providing their routine clinical care.  We also provided local antibiotic guidelines and regular educational sessions once a rotation.

We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority.  We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested.

Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients.

Medical Research: What should clinicians and patients take away from your report?

Dr. Lee: The CDC had previously proposed that clinicians take an antibiotic “time-out” to re-evaluate antibiotics in their patients.  Through building a structured review of all patients on antibiotics we supported and formalized this process allowing us to achieve reductions in specific antibiotic use and costs.  This was done without the need to engage external human resources or purchase new information technology solutions.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Lee: Since this study was done on a clinical teaching unit, the long term benefits on prescribing behavior for our resident physicians and students, if any, will need to be evaluated.

Subsequent next steps would be to refine and improve the checklist tool and to demonstrate that this type of approach could work in other centers and other care settings.  Furthermore we need to evaluate the durability of this type of intervention.


Antibiotics Self-stewardship: Trainee-led Structured Antibiotics Time-Outs to Improve Antimicrobial Use

Lee TC, Frenette C, Jayaraman D, Green L, Pilote L. Antibiotic Self-stewardship: Trainee-Led Structured Antibiotic Time-outs to Improve Antimicrobial Use. Ann Intern Med. 2014;161:S53-S58. doi:10.7326/M13-3016