Impact of a Simple Automated Best Practice Alert (BPA) on Quantity and Quality of In-hospital Antibiotic Use in a Tertiary and Three Secondary Hospitals (TARGET)

Insel Gruppe AG, University Hospital Bern

Status: Active, not recruiting

Conditions: Antibiotic Prescriptions; In-Patient Treatment

Treatments: Behavioral: Computerized decision support by best practice alert (BPA)

Study type: Interventional

Funder types: Other

Identifiers

NCT07115966

2025-00735

Details and patient eligibility

About

The goal of the stepped-wedge cluster-randomized trial is to assess the impact of an antimicrobial stewardship intervention: a simple, automated Best Practice Alert (BPA) that reminds prescribers to reevaluate antibiotic therapy after 72 hours (or 24 hours for prophylaxis), in accordance with guideline recommendations. The primary hypothesis is that this simple BPA reduces antibiotic use in terms of quantity (amount and duration) and quality (spectrum breadth), measured by days of antibiotic spectrum coverage at the patient level (primary outcome), as well as at both patient and cluster levels using various metrics of antibiotic use. The trial will introduce the BPA in a stepwise manner, with all wards implementing it by the end. It will compare the intervention period to the baseline (pre-intervention) and control periods.

Enrollment: 58 estimated patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• All inpatient wards with at least 50 PA/year, except those listed in the exclusion criteria

Exclusion criteria

Ward level:

• Emergency departments
• Outpatient clinics
• Haemato-oncologic stem cell transplant wards, where daily ID visits are performed
• ICU wards, where daily ID visits are performed

Indvidual patient data for analysis

• Refusal of institutional general consent for further use of patient data

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Sequential Assignment

Masking: Single Blind

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58 participants in 2 patient groups

Best practice alert (BPA)

Experimental group

Description:

Intervention: The BPA will appear to the prescribing physician for every patient on the respective ward. Activation of the BPA is ward-based. A total of 58 wards will be stratified according to their focus-surgical, medical, intermediate care, rehabilitation, or pediatric-and grouped based on their baseline antibiotic consumption, measured in days of antibiotic spectrum coverage per patient admission (DASC/PA). This stratification will result in 9 to 10 clusters across 6 groups. The clusters will then be randomized to the timing of BPA activation, and all wards will sequentially switch to the BPA arm every 2 months over a 12-month period. By the end of the trial, after 12 months, all wards will be using the automated BPA.

Treatment:

Behavioral: Computerized decision support by best practice alert (BPA)

Controls - No BPA

No Intervention group

Description:

Control: standard patient care with no BPA activated. By the end of the trial, after 12 months, all wards will be using the automated BPA.