In a new episode of the Rethinking Clinical Trials Podcast, Shruti Gohil and Jeffrey Guy discussed key takeaways from “INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection for Patients,” also known as the INSPIRE trial.
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INSPIRE, an NIH Collaboratory Trial, involved more than 300,000 patients in 92 HCA Healthcare hospitals. In half of the hospitals, clinicians received computerized alerts with information about the best antibiotic match for non-critically ill patients with abdominal or skin and soft tissue infection.
“Typically, these are engagements that create some sort of friction or that slow the tempo of care down. There was no slowing of the care tempo and it wasn’t creating friction, which I felt led to greater clinician adoption,” Guy said.
The study team found a 35% improvement in antibiotic selection for abdominal infection patients and a 28% improvement for skin and soft tissue infection patients. The magnitude of the effect exceeded the INSPIRE team’s expectations, and Guy and Gohil each shared insights into the drivers of the intervention’s success.
“This wasn’t just any other prompt physicians are used to seeing – Best Practice Alerts and alerts where you don’t get information back. This was a prompt that was developed to give clinicians information. What the trials show is that when you give clinicians meaningful information, you get results that can be quite powerful,” Gohil said.
INSPIRE was supported within the NIH Pragmatic Trials Collaboratory by a grant from the National Institute of Allergy and Infectious Diseases. The primary results were reported this year in JAMA Internal Medicine and JAMA Surgery.
Gohil is a co-principal investigator for INSPIRE and assistant professor of infectious diseases at the University of California, Irvine School of Medicine. Guy is the Corporate Vice President of Care Process Design at HCA Healthcare.