Discharge Antibiotic Stewardship for Pediatric Infections
(DISCO Trial)

Recruiting in Palo Alto (17 mi)

+4 other locations

Overseen byJeffrey S Gerber, MD, PhD

Age: < 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: Children's Hospital of Philadelphia

No Placebo Group

Trial Summary

What is the purpose of this trial?

The goal of this interventional study is to test if a discharge stewardship bundle is effective at reducing inappropriate antibiotic prescriptions at hospital discharge for children with the three common infections: community-acquired pneumonia (CAP), urinary tract infections (UTI), and skin/soft tissue infections (SSTI). The goals of this study are: * To develop, locally adapt, and implement a discharge stewardship intervention across four geographically diverse children's hospitals. * To measure the impact of the discharge stewardship intervention on antibiotic prescribing and patient outcome for three common pediatric infections. Families who are enrolled in the study will be asked to: * complete a one question wellness track on days 3, 7, and 21 after hospital discharge * complete a brief survey on days 7 and 21 after hospital discharge The study team will conduct interviews with the hospitalists at each of the four participating hospitals to create a "discharge stewardship" bundle. Once the bundle intervention is implemented, the hospitalists will be asked to follow prescribing guidelines for CAP, UTI, and SSTI. They will receive regular group-level feedback reports to show how well they follow the guidelines and motivate the hospitalists to follow the guidelines better.

Eligibility Criteria

This trial is for children under 18 with common infections like pneumonia, UTIs, or skin infections who are being discharged from the hospital. It's also for their parents and healthcare providers over 18 working at the hospital. Children who stayed in the hospital longer than a week or needed intensive care are not eligible.

Inclusion Criteria

Parent: Parent of eligible child

I am under 18 and have pneumonia, a UTI, or a skin infection, treated and released.

I am over 18 and work in the hospital as a healthcare professional.

Exclusion Criteria

Parent: Parent of ineligible child

I am over 18, have been in the hospital for more than 7 days, and need intensive care.

I am under 18 and do not work for the hospital.

Treatment Details

Interventions

Discharge antibiotic stewardship intervention (Behavioral Intervention)

Trial OverviewThe study tests a 'discharge stewardship bundle' to see if it helps reduce unnecessary antibiotic prescriptions when kids leave the hospital after treatment for pneumonia, UTI, or skin infections. The intervention will be adapted and implemented across four children's hospitals.

Participant Groups

2Treatment groups

Experimental Treatment

Active Control

Group I: Pediatric HospitalistsExperimental Treatment1 Intervention

Prescribing physicians and hospital employees will be recruited during regularly held staff meetings prior to the data collection period. The study team will briefly introduce the study aims and methods and let the hospitalists know that the study team will be emailing them separately to ask permission for Dr. Szymczak to shadow them. Only those who have agreed will participate in the ethnographic observations. For the interviews and surveys, the study team will recruit respondents via contact made during ethnographic observations. The study team will also utilize a snowball approach by asking respondents if they know of any other staff who might be interested in participating in an interview. Approximately 120 clinicians will participate in the interviews and surveys.

Group II: Families of hospitalized childrenActive Control1 Intervention

Families of children who were hospitalized at one of the four participating sites will be approached for consent to participate in the study. Families who consent will complete 2 brief REDCap surveys and a wellness tracker after their child is discharged from the hospital.