Impact of incorporating electronic medical record tools on optimal antibiotic durations at discharge for uncomplicated community-acquired pneumonia: a quasi-experimental study

Abstract Objective: To evaluate the impact of electronic medical record (EMR) transitions of care tools on antibiotic durations for uncomplicated community-acquired pneumonia (CAP). Design: IRB-approved, quasi-experiment. Setting: Five acute-care hospitals in Michigan. Patients: Hospitalized adults with uncomplicated CAP between 07/01/2023 and 11/30/2023 (pre-intervention) and 07/01/2024 and 11/30/2024 (post-intervention) were included. Patients were excluded if antibiotics were completed prior to discharge date, admitted to intensive care unit, respiratory culture with methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa ≤12-months before admission, suspected concomitant infection, or complicated CAP. Methods: EMR tools implemented March–May 2024 included a total antibiotic days counter and an inpatient stop date carryover on discharge order. The primary outcome was the proportion of patients prescribed ≤6-calendar-days of therapy. Secondary outcomes included 30-day CAP-related readmission, Clostridioides difficile infection (CDI), multidrug-resistant organisms (MDRO) ≤90-days of discharge, and days of therapy prescribed at discharge. Results: 234 patients were included: 124 pre- and 110 post-intervention. A higher proportion of post-intervention patients received ≤6-days of therapy (54% pre- vs 72.7% post-intervention, P = 0.003). No notable differences were seen in CDI or MDROs. Pre-intervention patients experienced more CAP-related readmissions (12.1% pre- vs. 4.5% post-intervention, P = 0.039) and more days of therapy at discharge 3-d (IQR 2–4) pre- vs. 2-d (IQR 1–4) post-intervention, P < 0.001. After adjustment for confounders, the post-intervention group had 2-fold increased odds of receiving ≤ 6-days of therapy for CAP (adjOR, 2.27; 95%CI, 1.31–3.93). Conclusion: Implementation of EMR transitions of care tools significantly improved antibiotic durations in hospitalized adults with CAP, without negatively impacting patient outcomes.