Staph Aureus Bacteremia
Conditions
Keywords
care pathway, infectious disease consultation
Brief summary
Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality rates with an incidence disproportionately higher in vulnerable populations. Management according to evidence-based care parameters, in particular Infectious Diseases (ID) consultation, is associated with improved mortality. SAB management is suboptimal in Alberta compared to other jurisdictions. An Alberta-based pilot study confirmed that timely recommendations to optimize SAB care, including ID consultation, was associated with improved adherence to all evidence-based quality-of-care indicators. Leveraging this pilot work, the investigators aim to implement OPTIMUS-SAB, an enhanced model of the pilot, to optimize and standardize SAB management across Alberta. The implementation study will be a zone-based acute care site stepped wedge design. OPTIMUS-SAB will consist of a centralized SAB care team whom will receive automated notification of all blood cultures positive for S. aureus allowing them to review the patient's medical chart and make preliminary management recommendations according to an evidence-based care bundle. The investigators will evaluate adherence to evidence-based SAB quality-of-care indicators before and after OPTIMUS-SAB implementation and expect this to improve with a resultant reduction in duration of bacteremia, length of stay, readmission rates, and mortality. In turn, this will translate into cost savings for the health care system.
Interventions
OTHEROPTIMUS-SAB clinical care pathway
Activation of SAB clinical care pathway within EMR system.
Sponsors
University of Alberta
Alberta Health services
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age greater than 18 years at the time of hospital admission * Confirmed S. aureus bacteremia by blood culture performed at a laboratory in Alberta, Canada * Admitted to a designated acute care site in Alberta, Canada
Exclusion criteria
* The treating team believes death is imminent or inevitable . * GCD are C-level within 48 hours of admission. * The patient is transferred in from an out-of-province acute care center with a pre-existing SAB diagnosis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adherence to quality-of-care indicators | Within 90 days | Defined as: 1. ID involvement and time to ID involvement, defined by the presence of an ID consult note and/or recommendations in the chart. 2. Repeat blood cultures, to document clearance of bacteremia, within 72 hours from the last positive blood culture. 3. Guideline-concordant empiric antibiotic administered and time to receipt. 4. Guideline concordant definitive antibiotic administered and time to receipt. 5. Therapeutic drug monitoring of patents treatments with vancomycin. 6. Appropriate dose adjustment of antimicrobials based on renal function according to local guidelines. 7. Echocardiogram (transthoracic or transesophageal) performed within 72 hours of diagnosis. 8. Source control achieved. 9. Appropriate duration of antibiotic therapy ordered and delivered. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of stay | 180 days maximum | Acute hospital length of stay |
| Hospital re-admission rates | 90 days | re-admission to acute care rate |
| All-cause mortality | 180 days | death from any cause |
| In hospital mortality | 90 days | death within hospital stay |
| Costing evaluation | One year | Cost of SAB treatment related to hospitalization, including physician provision of care, and antibiotics. |
| Implementation evaluation | 3 years | User experience and feedback from patients and providers will be collected at the start and end of each active implementation phase. This information will be paired with assessments of barriers, facilitators, and contextual factors informed by the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory during the pre-implementation phase and at the end of active implementation. |
Countries
Canada
Contacts
PRINCIPAL_INVESTIGATORJustin Chen, MD
University of Alberta
Outcome results
None listed