SHM Converge Scientific Abstract ePoster Gallery-Culture Change: De-Escalating From Intravenous to Oral Antibiotics

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This quality improvement project aimed to increase conversion from IV to oral antibiotics and encourage use of the Firstline antibiotic stewardship app in hospitalized adults with community-acquired pneumonia or UTI at an urban tertiary hospital.<br /><br />The intervention was led by medical and nursing students and included educational outreach to individual attendings and faculty groups, pre-service reminder emails, EMR screening for eligible patients, direct EMR messages to attending physicians, and IV-to-PO recommendations using Firstline.<br /><br />Among 46 hospitalized patients who met eligibility criteria (afebrile, culture data available, and on an enteral diet), 19 patients (41.3%) were successfully de-escalated from IV to PO antibiotics. The remaining 27 patients (58.7%) did not switch because of barriers such as medical complexity, multidrug-resistant organisms without oral alternatives, and inability to tolerate oral intake.<br /><br />Survey results suggested that attending physicians increased their use of Firstline after the intervention. Overall, the project showed that targeted provider outreach and education improved antibiotic de-escalation and stewardship app adoption. However, the findings also suggest that patient complexity is often not fully captured in the EMR, making full automation of IV-to-PO conversion difficult. The authors propose that integrating de-escalation into routine multidisciplinary workflows, such as with unit- or team-based pharmacists, and potentially using large language models may help make the intervention more sustainable.

Asset Subtitle

Anne S. Linker

Meta Tag

Author List Anne S. Linker, Avneet Kaur, Benjamin Dempsey, Cristina Cusmai, David Lin, Denny Kim, Eloka Anemelu, Henry Diamond-Pott, Julie M. Pearson, Katherine Langer, Michelle Avillo, Nicole Ondrush, Noah Silver-Beck, Rachel Chasan, Sophia De Oliveira, Vinh-Tu

Category Research

Concept Intravenous Antibiotic Therapy

Concept Oral Antibiotic Therapy

Concept Antibiotic De-escalation

Concept Catheter-Associated Complication

Concept Antibiotic Resistance

Distinguished Non-Finalist

Presenter Organization Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai

Presenting Author Anne S. Linker

Track Quality Improvement

Keywords

antibiotic stewardship

IV to oral conversion

community-acquired pneumonia

urinary tract infection

Firstline app

hospitalized adults

quality improvement

educational outreach

EMR screening

de-escalation

Intravenous Antibiotic Therapy

Oral Antibiotic Therapy

Antibiotic De-escalation

Catheter-Associated Complication

Antibiotic Resistance