# Implementing a Discharge Stewardship Bundle to improve antibiotic use at transition from hospital to home

> **NIH AHRQ R01** · CHILDREN'S HOSP OF PHILADELPHIA · 2024 · $472,247

## Abstract

Project Summary / Abstract
Pediatric antibiotic stewardship programs (ASPs) in hospital and outpatient settings optimize the use of
antibiotics to improve clinical outcomes, decrease adverse drug events, and reduce the emergence of
antibiotic resistant bacteria. However, stewardship for patients at the transition from hospital discharge to
home, or “discharge stewardship,” is an unmet need for several reasons. First, few pediatric stewardship
programs perform discharge stewardship. Second, approximately 30% of pediatric patients receive antibiotics
at hospital discharge. Third, the majority of antibiotic days prescribed for hospitalized patients occur after
discharge. Fourth, up to half of discharge antibiotic prescriptions are suboptimal, which includes choosing the
wrong drug, dose, route, or duration of therapy. This project will use an implementation science framework to
develop, implement, and test the effectiveness of a multifaceted discharge stewardship intervention for
hospitalized children with the three most common indications for antibiotic prescribing in hospitalized children -
community-acquired pneumonia (CAP), urinary tract infections (UTI), and skin/soft tissue infections (SSTI) - at
four children's hospitals to establish a foundation for future expansion to additional target populations.
Antibiotic choice, dose, route, and duration of therapy will be addressed. Aim 1 is to develop, locally adapt, and
implement a discharge stewardship intervention across the four participating sites. The integrated Promoting
Action on Research Implementation in Health Services (i-PARIHS) framework will guide a rapid formative
evaluation to identify contextual factors likely to facilitate or hinder the implementation of a discharge
stewardship intervention at each site. Based on these results, local facilitators will work to develop and
implement a discharge stewardship intervention comprised of consensus driven clinical prescribing guidelines
for CAP, UTI, and SSTI plus quarterly feedback of prescribing data based on these guidelines. Aim 2 is to
measure the impact of the discharge stewardship intervention on antibiotic prescribing (the primary outcome)
and patient-centered balancing measures. For the primary outcome, suboptimal antibiotic prescribing, we will
use retrospective data collection leveraging validated diagnostic code-based algorithms to maximize
consistency and feasibility for future dissemination. For the balancing metrics, treatment failure and post-
discharge adverse drug events, we will use prospective data collection from parents of patients with CAP, UTI,
and SSTI to maximize their capture. Both sub-aims will utilize a time series analysis based on 18 months of
pre-intervention data followed by 30 months of post-intervention data. This project will form the foundation for
future dissemination of discharge stewardship to a broader array of patient populations. Investigators on this
proposal form the leadership of the Sharing Anti...

## Key facts

- **NIH application ID:** 10903723
- **Project number:** 5R01HS027428-05
- **Recipient organization:** CHILDREN'S HOSP OF PHILADELPHIA
- **Principal Investigator:** Jeffrey Stephen Gerber
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $472,247
- **Award type:** 5
- **Project period:** 2020-08-01 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10903723

## Citation

> US National Institutes of Health, RePORTER application 10903723, Implementing a Discharge Stewardship Bundle to improve antibiotic use at transition from hospital to home (5R01HS027428-05). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10903723. Licensed CC0.

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