SHM Converge Scientific Abstract ePoster Gallery-Development of Antibiotic Metrics for Hospitalists via Modified Delphi Survey

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This document describes a multi-institutional modified Delphi survey designed to create an antibiotic-use scorecard for hospital medicine physicians. The goal was to identify metrics that are relevant, actionable, and retrievable from the electronic medical record, so clinicians can receive individualized feedback on their prescribing.<br /><br />Background: Excess antibiotic prescribing contributes to antimicrobial resistance and exposes patients to unnecessary harms. Prior work shows that specific feedback and scorecards can improve adherence to quality metrics.<br /><br />Methods: The study used two survey rounds. In Round 1, 21 hospitalists from 10 U.S. institutions rated candidate antibiotic metrics. Metrics rated 3/5 or higher by at least 70% of respondents moved to Round 2. Sixteen participants completed Round 2, and metrics rated 4/5 or higher by at least 80% were included in the final set. This process produced a final scorecard of 16 metrics.<br /><br />Results: The most highly rated metrics focused on:<br />- appropriate de-escalation to the narrowest antibiotic in culture-documented infections,<br />- appropriate antibiotic duration for acute cystitis,<br />- follow-up blood cultures in Staphylococcus aureus bacteremia,<br />- appropriate antibiotic selection for community-acquired pneumonia,<br />- appropriate treatment for skin and soft tissue infections.<br /><br />The single metric most often chosen as “most relevant” by participants was days of antibiotic therapy adjusted for patient volume, though it did not meet the formal inclusion threshold.<br /><br />Conclusion: The consensus process identified 16 antibiotic stewardship metrics that hospitalists viewed as useful for feedback on infection diagnosis and treatment. The next steps include prioritizing the top five metrics, collecting scorecard data through prevalence surveys, and using focus groups to understand clinician reactions to the scorecard.

Asset Subtitle

Allison Bond

Meta Tag

Author List Allison Bond, Emily Abdoler, Priya A. Prasad, Sandra Oreper, Sarah Doernberg

Category Research

Concept Antibiotic Prescribing

Concept Antibiotic Resistance

Concept Antibiotic Quality Metric

Concept Patient Harm

Concept Delphi Technique

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Allison Bond

Track Quality Improvement

Keywords

Delphi survey

antibiotic stewardship

hospital medicine

scorecard

prescribing feedback

electronic medical record

antimicrobial resistance

hospitalists

quality metrics

infection treatment

Antibiotic Prescribing

Antibiotic Resistance

Antibiotic Quality Metric

Patient Harm

Delphi Technique