immediate responses that guide providers in performing interventions that are based on practice guidelines. The LDS Hospital has a highly advanced information system that maintains each patient's medication records and warns the pharmacy of potential drug interactions or allergic reactions. It also suggests medications for specific patients on the basis of prescription guidelines and current indicators such as white cell count, fever, and results of microbiological cultures and roentgenograms. In the case of emerging infections, the system also alerts the physician to infections caused by multiple-drug-resistant organisms or to a prescription that is at odds with what would normally be prescribed.

The goal of the system is flexible, informed decision making. The system includes bedside monitors that provide monographs on formulary antibiotics, as well as each nursing unit's history of nosocomial infections and the susceptibility patterns of the strains that caused those infections. An outpatient model provides guidance for the treatment of otitis media, pharyngitis, and urinary tract infections based on the cost of antimicrobial agents adjusted for patient-specific factors such as height, weight, and renal function. All of this is designed to make the system easy to use and thus promote its use; physicians, for example, find that it has greatly simplified the task of prescribing antibiotics.

Analysis of practice over the past 11 years at LDS Hospital indicates that the proportion of patients receiving antibiotics has increased from 32 to 54 percent, which may represent LDS Hospital's rising role as the main referral center for a 23-hospital system. However, the number of patients receiving antibiotics does not adequately reflect the antibiotic exposure of this population. Further analysis shows that the number of defined daily doses per 1,000 patient-days has decreased by 40 percent and that the cost of medication declined from $122 to $52 per antibiotic-treated patient over the same period. In addition, the incidence of adverse drug events due to antibiotics has declined by 60 to 70 percent, and there has been little change in the levels of antibiotic resistance. The research question being pursued is whether surveillance and monitoring have affected antibiotic resistance. The hope is that patient-specific use of information will stabilize antibiotic resistance and lead to a more sophisticated type of informed decision making, one that will control costs as well as prevent the emergence or reemergence of antibiotic resistance.

Laboratory-Based Reporting and Managing Encounter-Level Data

Presented by Richard Dixon, M.D., FACP

Medical Director, National Independent Practice Association Coalition

If surveillance for emerging and changing infection trends is to be effective, diagnoses must be accurate, reported in a standardized manner, and monitored. Sources of information on infections include voluntary reports of clinical diag-



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