High- vs. Low-Intensity Prospective Audit and Feedback on Internal Medicine Wards and Impact on Antimicrobial Use at a Community Hospital
Bibliographic record
Abstract
Antimicrobial stewardship program (ASP) interventions, such as prospective audit and feedback (PAF), have been shown to reduce antimicrobial use and improve patient outcomes. However, there is a lack of data comparing different PAF approaches. We examined the impact of a high-intensity interdisciplinary rounds-based PAF compared with low-intensity PAF on antimicrobial use on internal medicine wards in a 400-bed community hospital. Prior to the intervention, low-intensity PAF was performed by ASP pharmacists with a focus on targeted antibiotics (fluoroquinolones, anti-pseudomonal penicilins, carbapenems, vancomycin, clindamycin, third-generation cephalosporins). Recommendations were made directly to the internist for each patient. High-intensity rounds-based PAF was introduced to 5 internal medicine wards sequentially. Rounds occurred twice weekly, reviewed internal medicine patients receiving any antimicrobial agent, and were interdisciplinary (ASP PharmD, internist, ward pharmacist, ASP MD). The primary outcome was antimicrobial use on internal medicine wards measured in defined daily doses (DDD) per 1000 patient-days (PD) 1–24 months prior compared with 1–24 months after the intervention. We performed interrupted time series analysis using linear regression to compare prescribing rates while accounting for autocorrelation within wards. Adjusted models included covariates to account for secular and seasonal trends. Following the intervention, there was a non-statistically significant drop in antimicrobial use from 469 to 435 DDD/1000 PD. See Table 1 and Figure 1 for analyses of antibiotic use. Although high-intensity PAF did not result in lower antibiotic use compared with low-intensity PAF overall, a delayed reduction (>12 months) in usage was seen. Prospective studies are needed to determine the optimal approach to PAF. Change in Antimicrobial Use After High-Intensity PAF (DDD/1000 PD) Antimicrobial Use on Internal Medicine Wards Before and After High-Intensity PAF All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.007 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".