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.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
2,542
Activation of SAB clinical care pathway within EMR system.
Athabasca Healthcare Centre
Athabasca, Alberta, Canada
Mineral Springs Hospital
Banff, Alberta, Canada
Barrhead Healthcare Centre
Barrhead, Alberta, Canada
Bassano Health Centre
Bassano, Alberta, Canada
Beaverlodge Municipal Hospital
Beaverlodge, Alberta, Canada
Oilfields General Hospital
Adherence to quality-of-care indicators
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.
Time frame: Within 90 days
Length of stay
Acute hospital length of stay
Time frame: 180 days maximum
Hospital re-admission rates
re-admission to acute care rate
Time frame: 90 days
All-cause mortality
death from any cause
Time frame: 180 days
In hospital mortality
death within hospital stay
Time frame: 90 days
Costing evaluation
Cost of SAB treatment related to hospitalization, including physician provision of care, and antibiotics.
Time frame: One year
Implementation evaluation
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.
Time frame: 3 years
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Black Diamond, Alberta, Canada
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Bonnyville, Alberta, Canada
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Bow Island, Alberta, Canada
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Boyle, Alberta, Canada
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Brooks, Alberta, Canada
...and 91 more locations