Earlier switching from intravenous to oral antibiotics owing to electronic reminders

• The impact of automated reminders to promote earlier intravenous (i.v.) to oral switching of antimicrobial therapies was studied.
• Patients eligible for switching 60 h after starting i.v. antimicrobials were identified.
• The 2-year, controlled, before-and-after trial was conducted in an 850-bed hospital.
• The mean duration of the initial i.v. therapies decreased by nearly a day due to the intervention.
• Savings of 737 days of i.v. antibiotic therapy per year were calculated.

Paper-based interventions have been shown to stimulate switching from intravenous (i.v.) to oral (p.o.) antibiotic therapies. Shorter i.v. durations are associated with a lower risk of iatrogenic infections as well as reduced workload and costs. The purpose of this study was to determine whether automated electronic reminders are able to promote earlier switching. In this controlled before-and-after study, an algorithm identified patients who were eligible for i.v.-to-p.o. switch 60 h after starting i.v. antimicrobials. Reminders offering guidance on the re-assessment of initial i.v. therapy were displayed within the electronic health records in 12 units during the intervention period (year 2012). In contrast, no reminders were visible during the baseline period (2011) and in the control group (17 units). A total of 22 863 i.v. antibiotic therapies were analysed; 6082 (26.6%) were switched to p.o. therapy. In the intervention group, 757 courses of i.v. antibiotics were administered for a mean ± standard deviation duration of 5.4 ± 8.1 days before switching to p.o. antibiotics in the baseline period, and 794 courses for 4.5 ± 5.5 days in the intervention period (P = 0.004), corresponding to a 17.5% reduction of i.v. administration time. In contrast, in the control group the duration increased; 2240 i.v. antibiotics were administered for a mean duration of 4.0 ± 5.9 days in the baseline period, and 2291 for 4.3 ± 5.8 days in the intervention period (P = 0.03). Electronic reminders fostered earlier i.v.-to-p.o. switches, thereby reducing the duration of initial i.v. therapies by nearly a day.