Background: Inpatient antibiotic stewardship programs often use pre-prescription approval (PPA) or prospective audit and feedback (PAF) to reduce fluoroquinolone prescribing. Whether these stewardship strategies targeting inpatient fluoroquinolone use also influence prescribing at discharge is unknown. Therefore, we aimed to evaluate the effect of fluoroquinolone stewardship on discharge fluoroquinolone use in patients with pneumonia or a [...]

Background: Antibiotics are frequently prescribed—and overprescribed—at hospital discharge, leading to adverse-events and patient harm. Antibiotic overuse at discharge varies widely across hospitals, with rates of overuse differing up to 5-fold.(1) Our understanding of what approaches optimize prescribing at discharge is limited. Recently, we published the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework which [...]

Background: Inpatient antibiotic stewardship programs often use pre-prescription approval (PPA) or prospective audit and feedback (PAF) to reduce fluoroquinolone prescribing. Whether these stewardship strategies targeting inpatient fluoroquinolone use also influence prescribing at discharge is unknown. Therefore, we aimed to evaluate the effect of fluoroquinolone stewardship on discharge fluoroquinolone use in patients with pneumonia or a [...]

Background: Urinary catheters, vascular catheters, and wounds such as pressure injuries are often hidden from view under gowns and sheets – out of sight, out of mind – contributing to prolonged catheter use, infections, delayed interventions, and diagnostic errors for symptoms (e.g., fever, delirium) related to catheters and wounds. We developed and pilot tested a [...]

Background: Urinary tract infection (UTI) and community acquired pneumonia (CAP) are the two most common infections treated in hospitalized patients and are often inappropriately diagnosed. Due to myriad factors—including diagnostic uncertainty—patients are commonly inappropriately diagnosed with UTI or CAP in the emergency department (ED). Antibiotics may be continued throughout the hospitalization even if new information [...]

Background: Hospital at home (HaH) programs have shown efficacy as substitutes for high-cost, traditional hospitalization in patients who are primarily low-acuity and with a range of medical conditions, including community-acquired pneumonia (CAP) and urinary tract infection (UTI). However, wide-spread adoption is minimal as providers and patients are challenged to consider HaH at the time of [...]

Background: The Society of Hospital Medicine’s Choosing Wisely guidelines recommend regular assessment of inpatients’ need for urinary catheters and telemetry monitoring. Since studies suggest clinicians are not aware which patients have an indwelling catheter or are on telemetry, we aimed to use the electronic patient list to improve cognitive awareness of unnecessary urinary catheters and [...]

Background: Infants ≤ 60 days of age with a urinary tract infection (UTI) are a challenging population. Without clear guidelines for management, there is variability in renal imaging and antibiotic use. Our study examined patterns of renal imaging and antibiotic use in infants ≤ 60 days of age with UTI at a tertiary care children’s [...]

Background: Inappropriate diagnosis of urinary tract infections (UTI) contributes to antibiotic overuse. We previously validated and refined a patient safety measure that defines inappropriate diagnosis of UTI (i.e., treatment of asymptomatic bacteriuria [ASB]) and was endorsed by the National Quality Forum. Use of this measure as a pay-for-performance metric in the Michigan Hospital Medicine Safety [...]

Background: Catheter-associated urinary tract infection (CAUTI) is a common and clinically important hospital-associated infection throughout the world. A few data from Japan exist regarding the prevalence and appropriateness of urinary catheters in hospitalized patients but no interventions have been proven to decrease unnecessary urinary catheter use in Japan. Our aim of this study is to [...]