1339. Impact of Implementing Procalcitonin Testing with Comprehensive Education on Procalcitonin Ordering Habits and Antibiotic Usage

Abstract

Abstract Background Procalcitonin (PCT) has emerged as a biomarker distinguishing bacterial from non-bacterial infections with FDA approval for acute respiratory infections and sepsis. Studies show that PCT use can reduce patient harm while decreasing antibiotic usage. Our objective was to evaluate PCT use at our hospital and assess the impact of a comprehensive education intervention. Methods In-house PCT testing was implemented at our institution April 2018 along with a rigorous education campaign. Interventions consisted of face-to-face didactics with 5 provider groups, distribution of evidence-based interpretation algorithms, development of EMR prompts to guide appropriate ordering, and creation of syndrome-specific interpretation displayed with PCT results. Retrospective analysis comparing pre-intervention (December 2017) to post-intervention (October 2018) was performed evaluating ordering habits and impact of PCT result on antibiotic management. Statistical analysis was performed using STATA 14.2. Results 218 PCT orders from 170 patients and 263 PCT orders from 170 patients were included in the pre- and post-intervention periods, respectively. All provider groups who received face-to-face education changed PCT ordering habits. Orders placed in ED and ICU locations increased (P < 0.01 and P = 0.01, respectively) while orders from floor locations decreased (P < 0.01). Serial PCT orders increased (20% vs. 33%; P < 0.01). PCT orders for FDA-approved indications improved (71% vs. 90%; P < 0.01) and following intervention, services who received in-person didactics were more likely to order PCT for FDA-approved indications than untrained groups (93% vs. 80%; P < 0.01). Clinicians were less likely to adjust therapy when PCT was low than when elevated in both periods (55% vs. 72%; P = 0.01; 61% vs. 77%; P = 0.01, respectively). Providers appropriately altered or continued therapy at similar rates during both periods (64% vs. 70%; P = 0.2). Conclusion Providing comprehensive PCT education significantly impacted PCT ordering habits. Testing improved to comply with FDA-approved indications, specifically in providers who received face-to-face education. Appropriate alteration of therapy based on PCT results were similar between groups suggesting repeat education is needed to avoid confirmation bias. Disclosures All authors: No reported disclosures.