Antibiotic Time Out

One of the Core Elements requirements of the Antimicrobial Stewardship is a provider-based intervention with all antibiotics called a “Time Out”. An antibiotic timeout is a provider-led reassessment (48-72 hours after beginning empiric antibiotics) of the continuing need and choice of antibiotics when the clinical picture is clearer and more diagnostic information, especially results of cultures and rapid diagnostics, is available.

Provider-led reviews of antibiotics can focus on four key questions:

• Does this patient have an infection that will respond to antibiotics?

• Have proper cultures and diagnostic tests been performed?

• Can antibiotics be stopped or improved by narrowing the spectrum (also referred to as “de-escalation”) or changing from intravenous to oral?

• How long should the patient receive the antibiotic(s), considering both the hospital stay and any post-discharge therapy?

Is it possible to require this reassessment by the physician on antibiotics? Possibly similar to the auto-stop notification? Send the doctor a message with these four questions on each antibiotic after 48 hours and require the provider to answer each with a drop down answer and the answer to the last question will result in a hard discontinue of this antibiotic. This information will also need to be pulled to a report for inspectors. If this is possible, we could “passively” meet these requirements for CMS.