scholarly journals P136: Increasing access to computed tomography scanning in the emergency department and its effect on patient outcomes

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S113
Author(s):  
M. Watson ◽  
C. Richard ◽  
N. Fortino ◽  
T. Lyon ◽  
R. Ohle
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Third Party ◽  
Direct Access ◽  
Ct Scans ◽  
Admission Rates ◽  
Computed Tomography Scanning ◽  
The Impact

Background: There is growing concern about emergency physicians overuse of computed tomography (CT). In an attempt to ensure appropriate ordering many hospitals implement strict protocols for ordering of CT scans in the emergency department (ED) that include approval of all scans by a board-certified radiologist, and a reduced access to CT overnight. Aim Statement: The aim of this study is to review the impact of RAD ED – direct access to CT ordering by ED physicians, 24hr CT technologist and third-party reporting on CT scans overnight. Our objectives were to assess the effect on; 1) ED length of stay, 2) number of CT scans ordered and 3) admission rates. Measures & Design: We conducted a prospective pilot before & after study at a single tertiary-care emergency department between February 1st, 2018 and July 31st, 2018. Inclusion criteria were adult patients presenting to the emergency department and undergoing CT for any of the following: face, neck, spine, upper and lower extremities, chest, abdomen and pelvis. Exclusion criteria were those undergoing CT head for stroke or trauma. Evaluation/Results: A total of 924 patients met our criteria, 352 before and 568 after implementation. Comparison of the patient populations demonstrate very similar characteristics in both groups; (49% male, average age 56 years, CTAS 2(40%) and 3(47%). Results demonstrate that an additional 216 scans were performed in post-implementation group. This equates to an increase of 61%. ED length of stay averaged 5.6 hours pre-implementation and 4.7 hours post-implementation. This corresponds to a significant reduction in length of stay of approximately 0.9 hours (p < 0.01). Collection is currently ongoing for factors that we will adjust for a multivariate analysis, including admission rates. Discussion/Impact: RAD ED led to a significant increase in CT ordering and decrease in ED length of stay. We believe that this project provides important information to clinicians and patients with regards to overall CT utilization, ED wait times, follow up visits for CT scanning and admission rates. It is also important for administrators to help decide if these new rules are leading to improved efficiency, and to help estimate their financial impact.

scholarly journals P064: Effect of increased availability of pre-authorized radiological test ordering on CT scan utilization in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S100-S100
Author(s):  
K. Huszarik ◽  
K. Wood ◽  
M. Columbus ◽  
A. Dukelow
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Ct Scan ◽  
Patient Flow ◽  
Tertiary Care ◽  
Ct Scans ◽  
Significant Difference ◽  
Implementation Period ◽  
Flow Through ◽  
The Impact

Introduction: Computed tomography (CT) scan utilization has increased dramatically over the past 25 years. This has sparked concern for potential overuse leading to unnecessary radiation exposure for patients and increased health care costs, without any improvement in health outcomes. In order to improve workflow through the Emergency Department (ED) at our institution, an existing pre-authorization policy during weekday business hours allows emergency physicians to order CT scans directly without the need for approval from a radiologist. This policy was recently expanded on September 28, 2015 to allow pre-authorized CT scan orders during weekday evening hours. The objective of our study is to evaluate the impact of increased availability of pre-authorized CT scan ordering on CT scan utilization and patient flow through the ED at two tertiary care hospitals in London, Ontario. Methods: This is a retrospective review comparing monthly CT scan utilization rates in the pre-implementation period from September 28, 2014 to February 28, 2015, to rates in the post-implementation period from September 28, 2015 to February 28, 2016. Length of stay parameters including time from physician initial assessment to CT scan order, completion, report and patient discharge will also be compared between the groups. Results: Results will be presented at CAEP 2016. No significant difference is expected in the monthly number of CT scans ordered per registered ED visits between the pre- and post-implementation groups. We also anticipate a significantly shorter average length of stay for patients receiving a CT scan in the post-implementation group. Conclusion: We expect there will be no significant increase in CT scan utilization with increased availability of pre-authorized CT scan ordering in our EDs. We also anticipated decreased patient length of stay leading to improved patient flow through the ED. Findings may offer support for organizations to safely implement or increase availability of pre-authorized CT scan orders to help improve patient flow and decrease costs in the ED.

scholarly journals P139: The impact of a pancreatitis admission algorithm on emergency department length of stay in a tertiary care academic hospital

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S114-S115
Author(s):  
A. Albina ◽  
F. Kegel ◽  
F. Dankoff ◽  
G. Clark
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Physician Satisfaction ◽  
Academic Hospital ◽  
Before And After ◽  
Potential Applicability ◽  
The Mean ◽  
Algorithm Implementation ◽  
The Impact

Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.

scholarly journals Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽  
2020 ◽  
Author(s):  
K Jusmanova ◽  
C Rice ◽  
R Bourke ◽  
A Lavan ◽  
C G McMahon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Admission Rate ◽  
Readmission Rates ◽  
Specialist Service ◽  
Admission Rates ◽  
Potential Benefits ◽  
Bed Days ◽  
The Mean ◽  
The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

scholarly journals P021: Impact of emergency department surge and end of shift on patient workup and treatment prior to referral to internal medicine

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S85-S85
Author(s):  
V. Charbonneau ◽  
I.G. Stiell ◽  
E.S. Kwok ◽  
L. Boyle
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Emergency Department ◽  
Tertiary Care ◽  
Time Of Day ◽  
Therapeutic Interventions ◽  
Weighted Mean ◽  
Admission Rates ◽  
Medicine Service ◽  
The Impact

Introduction: The goal of this study was to determine if emergency department (ED) surge and end of shift assessment of patients affect the extent of diagnostic tests, therapeutic interventions performed and accuracy of diagnosis prior to referral of patients to Internal Medicine as well as the impact on patient outcomes. Methods: This study was a health records review of consecutive patients referred to the internal medicine service with an ED diagnosis of heart failure, COPD or sepsis, at two tertiary care EDs. We developed a scoring system in consultation with senior emergency and internal medicine physicians to uniformly assess the treatments and investigations performed for patients diagnosed in the ED with heart failure, COPD or sepsis. These scores were then correlated with surge levels and time of day at patient assessment and disposition. Rate of admission and diagnosis disagreements were also assessed. Results: We included 308 patients (101 with heart failure, 101 with COPD, 106 with sepsis). Comparing middle of shift to end of shift, the overall weighted mean scores were 92.2% vs. 91.7% for investigations and 73.5% vs. 70.0% for treatments. Comparing low to high surge times, the overall weighted mean scores were 89.9% vs. 92.6% for investigations and 68.6% vs. 71.7% for treatments. Evaluating each condition separately for investigations and treatments according to time of shift or surge conditions, there were no consistent differences in scores. We found overall high admission rates (93.1 % for heart failure, 91.1% for COPD, 96.2% for sepsis patients), and low rates of diagnosis disagreement (4.0 % heart failure, 10.9% COPD, 8.5% sepsis). Conclusion: We found that surge levels and end of shift did not impact the extent of investigations and treatments provided to patients diagnosed in the emergency department with heart failure, COPD or sepsis and referred to internal medicine. Admission rates for the patients referred were above 90% and there were very few diagnosis disagreements or diversion to alternate service by internal medicine. We believe this supports the emergency physician's ability to adapt to time and surge constraints, particularly in the context of commonly encountered conditions.

scholarly journals The Value of Thoracic Computed Tomography Scans in Clinical Diagnosis: A Prospective Study

2006 ◽  
Vol 13 (6) ◽  
pp. 311-316 ◽  
Author(s):  
Mark O Turner ◽  
John R Mayo ◽  
Nestor L Müller ◽  
Michael Schulzer ◽  
J Mark FitzGerald
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Clinical Diagnosis ◽  
Waiting Times ◽  
Tertiary Care ◽  
Ct Scans ◽  
Thoracic Ct ◽  
Chest Disease ◽  
Before And After ◽  
The Impact

BACKGROUND: Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross-sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available.OBJECTIVE: To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses.DESIGN: A before and after survey of physicians who had ordered thoracic CT scans.SETTING: Vancouver General Hospital – a tertiary care teaching centre in Vancouver, British Columbia.SUBJECTS: Physicians who had ordered CT scans.INTERVENTION: Physicians completed a standard questionnaire before and after the CT scan result was available.MEASUREMENTS: Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times.RESULTS: Four hundred fifty-four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High-priority scans were associated with decreased waiting time (−7.89 days for each unit increase in priority).CONCLUSIONS: The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.

scholarly journals Analysis of factors influencing length of stay in the emergency department

CJEM ◽  
2003 ◽  
Vol 5 (03) ◽  
pp. 155-161 ◽  
Author(s):  
Philip Yoon ◽  
Ivan Steiner ◽  
Gilles Reinhardt
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Care ◽  
Linear Regression Analysis ◽  
Tertiary Care ◽  
Future Research ◽  
Consultation Rate ◽  
Lengths Of Stay ◽  
The Impact ◽  
Triage Level

ABSTRACTObjectives:Length of stay (LOS) is a key measure of emergency department (ED) throughput and a marker of overcrowding. Time studies that assess key ED processes will help clarify the causes of patient care delays and prolonged LOS. The objectives of this study were to identify and quantify the principal ED patient care time intervals, and to measure the impact of important service processes (laboratory testing, imaging and consultation) on LOS for patients in different triage levels.Methods:In this retrospective review, conducted at a large urban tertiary care teaching hospital and trauma centre, investigators reviewed the records of 1047 consecutive patients treated during a continuous 7-day period in January 1999. Key data were recorded, including patient characteristics, ED process times, tests performed, consultations and overall ED LOS. Of the 1047 patient records, 153 (14.6%) were excluded from detailed analysis because of incomplete documentation. Process times were determined and stratified by triage level, using theCanadian Emergency Department Triage and Acuity Scale(CTAS). Multiple linear regression analysis was performed to determine which factors were most strongly associated with prolonged LOS.Results:Patients in intermediate triage Levels III and IV generally had the longest waiting times to nurse and physician assessment, and the longest ED lengths of stay. CTAS triage levels predicted laboratory and imaging utilization as well as consultation rate. The use of diagnostic imaging and laboratory tests was associated with longer LOS, varying with the specific tests ordered. Specialty consultation was also associated with prolonged LOS, and this effect was highly variable depending on the service consulted.Conclusions:Triage level, investigations and consultations are important independent variables that influence ED LOS. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS. Improved information systems will facilitate similar ED time studies to assess key processes, lengths of stay and clinical efficiency.

scholarly journals LO86: Overutilization of computed tomography as a first-line investigation for patients presenting with suspected recurrent nephrolithiasis in the emergency department: a retrospective cohort study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S57-S58
Author(s):  
J. Himelfarb ◽  
J.S. Lee ◽  
D. Shelton
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Renal Colic ◽  
Eligible Patient ◽  
Tertiary Care ◽  
Ct Imaging ◽  
Choosing Wisely ◽  
System Level ◽  
Ct Scans ◽  
History Of

Introduction: Computed tomography (CT) has increasingly been used as a standard initial investigation for patients presenting to the Emergency Department (ED) with suspected nephrolithiasis. Compared to ultrasound, CT has increased system-level costs, ionizing radiation exposure and frequently does not alter management. For these reasons, Choosing Wisely (CW) recommends avoiding CT imaging of otherwise healthy patients younger than age 50 years presenting with symptoms of uncomplicated renal colic that have a known history of nephrolithiasis or ureterolithiasis. We aimed to evaluate the degree of utilization of CT imaging for this subgroup of patients in a tertiary care centre ED. Methods: A retrospective chart review was performed for all patients younger than 50 years who visited Sunnybrook Health Sciences Centre ED for six months between December 2015 and May 2016 with renal colic symptoms and a history of nephrolithiasis. Demographic data, relevant past medical history, clinical presentation, lab values, urology consultation, ED treatments administered, diagnostic imaging orders and dispositions were recorded for each eligible patient. Results: Out of 130 reviewed patient charts, 73 patients were identified with a previous history of nephrolithiasis and a presentation consistent with uncomplicated renal colic. 54 patients received ultrasound, KUB x-ray, or no imaging. The other 19 (26.0%) of these patients received an abdominal/pelvic CT with an indication of looking for renal or ureteral stones. Of the patients that received CT, none demonstrated significant findings warranting hospital admission or leading to identifiable changes in ED management. Five (26.3%) of these 19 patients had received a total of three to four CTs for renal colic during past Sunnybrook ED visits, while one had previously received 13 CTs. Conclusion: CT scans are often used as an initial diagnostic modality for suspected renal colic despite a Choosing Wisely recommendation to restrict the use of CT scans in a target population and infrequent changes in management after obtaining a CT. These findings highlight the need for quality improvement strategies to decrease CT utilization in this patient population with suspected renal colic.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Rapid Multiplex Testing for Upper Respiratory Pathogens in the Emergency Department: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Larissa May ◽  
Grant Tatro ◽  
Eduard Poltavskiy ◽  
Benjamin Mooso ◽  
Simson Hon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Usual Care ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Respiratory Pathogens ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections ◽  
The Impact

Abstract Background Acute upper respiratory tract infections are a common cause of Emergency Department (ED) visits and often result in unnecessary antibiotic treatment.  Methods We conducted a randomized clinical trial to evaluate the impact of a rapid, multi-pathogen respiratory panel (RP) test versus usual care (control). Patients were eligible if they were ≥12 months old, had symptoms of upper respiratory infection or influenza like illness, and were not on antibiotics. The primary outcome was antibiotic prescription; secondary outcomes included antiviral prescription, disposition, and length of stay (ClinicalTrials.gov# NCT02957136). Results Of 191 patients enrolled, 93 (49%) received RP testing; 98 (51%) received usual care. Fifty-three (57%) RP and 7 (7%) control patients had a virus detected and reported during the ED visit (p=0.0001). Twenty (22%) RP patients and 33 (34%) usual care patients received antibiotics during the ED visit (-12% [95% CI -25%, 0.4%]; p=0.06/0.08); 9 RP patients received antibiotics despite having a virus detected. The magnitude of antibiotic reduction was greater in children (-19%) versus adults (-9%; post-hoc analysis). There was no difference in antiviral use, length of stay, or disposition. Conclusions Rapid RP testing was associated with a trend towards decreased antibiotic use, suggesting a potential benefit from more rapid viral tests in the ED. Future studies should determine if specific groups are more likely to benefit from testing and evaluate relative cost and effectiveness of broad testing, focused testing, and a combined diagnostic and antimicrobial stewardship approach.

THE IMPACT OF ANTIMICROBIAL STEWARDSHIP ON THE PATTERNS OF ANTIBIOTICS’ PRESCRIPTION AND CLINICAL OUTCOMES IN THE MEDICAL WARD OF A MALAYSIAN TERTIARY CARE HOSPITAL

2021 ◽  
pp. 20-25
Author(s):  
OVAIS ULLAH SHIRAZI ◽  
NORNY SYAFINAZ AB RAHMAN ◽  
CHE SURAYA ZIN ◽  
HANNAH MD MAHIR ◽  
SYAMHANIN ADNAN
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Medical Ward ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Slope Change ◽  
The Impact

Objective: To evaluate the impact of antimicrobial stewardship (AMS) on antibiotic prescribing patterns and certain clinical outcomes, the length of stay (LOS) and the re-admission rate (RR) of the patients treated within the medical ward of a tertiary care hospital in Malaysia. Methods: This quasi-experimental study was conducted retrospectively. The prescriptions of the AMS included alert antibiotics (AA) such as cefepime, ceftazidime, colistin (polymyxin E), imipenem-cilastatin, meropenem, piperacillin-tazobactam and vancomycin were reviewed for the period of 24 mo before (May, 2012–April, 2014) and after (May, 2014–April, 2016) the AMS implementation for the patients who were treated within the medical ward of a Malaysian tertiary care hospital. Patterns of antibiotics prescribed were determined descriptively. The impact of the AMS on the length of stay (LOS) and readmission rate (RR) was determined by the interrupted time series (ITS) comparative analysis of the pre-and post-AMS segments segregated by the point of onset (May, 2014) of the AMS program. Data analysis was performed through autoregressive integrated moving average (ARIMA) Winter Additive model and the Games-Howell non-parametric post hoc test by using IBM Statistical Package for Social Sciences version 25.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: A total of 1716 prescriptions of the AA included for the AMS program showed that cefepime (623, 36.3%) and piperacillin-tazobactam (424, 24.7%) were the most prescribed antibiotics from May 2012 to April 2016. A 23.6% drop in the number of the AA prescriptions was observed during the 24-month post-AMS period. The LOS of the patients using any of the AA showed a post-AMS decline by 3.5 d. The patients’ LOS showed an average reduction of 0.12 (95% CI, 0.05–0.19, P=0.001) with the level and slope change of 0.18 (95% CI, 0.04–0.32, P=0.02) and 0.074 (95% CI, 0.02–0.12, P=0.002), respectively. Similarly, the percent RR reduced from 20.0 to 9.85 during the 24-month post-AMS period. The observed post-AMS mean monthly reduction of the RR for the patients using any AA was 0.38 (95% CI, 0.23–0.53, P<0.001) with the level and slope change of 0.33 (95% CI, 0.14–0.51, P=0.02) and 0.37 (95% CI, 0.16–0.58, P=0.001), respectively. Conclusion: The AMS program of a Malaysian tertiary care hospital was a coordinated set of interventions implemented by the AMS team of the hospital that comprised of the infectious diseases (ID) physician, clinical pharmacists and microbiologist. The successful implementation of the AMS program from May, 2014 to April, 2016 within the medical ward resulted in the drop of the number of AA prescriptions that sequentially resulted in the significant (P<0.05) post-AMS reduction of the LOS and the RR.

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