Description of the project: The timely initiation of appropriate antibiotics is critical both for individual patient outcomes and institutional goals of reducing antibiotic resistance, shortening hospital stays, and complying with pneumonia and sepsis core measures. However, the correct antibiotic choice for the same indication varies depending on local resistance patterns and hospital formularies, making it challenging to identify the ideal antibiotic in a given circumstance. For instance, the correct antibiotic for community-acquired pneumonia might include Ceftriaxone at Moffitt-Long hospital, but Ertapenem at the VA. Even after the appropriate antibiotic is selected, the dosing must be further individualized to account for a patient’s weight, and renal and hepatic function. Vancomycin, for example, is frequently dosed incorrectly, exposing patients to over- and under-dosing and reducing provider efficiency.

The Infectious Disease Management Program (IDMP) is an interdisciplinary collaboration designed to provide guidance in selecting and dosing the correct antibiotics for various clinical indications specific to each site. We would like to provide this information in a quickly and easily accessible format suitable for point-of-care use. We aim to develop a mobile phone app that will allow physicians to quickly identify ideal site-specific antibiotic choices for commonly encountered infections and to provide preferred dosing regimens.

Deliverables: UCSF IDMP, an application built for Apple's iOS (compatible with iPhone, iPad, and iPod Touch; an Android-compatible version would be considered if there is demand) that will be freely downloadable from the Apple App Store. This app will provide prescribers with recommended empiric regimens for a variety of conditions (e.g. sepsis, UTI, community-acquired pneumonia), suggested dosing for all antimicrobials, and hospital-specific microbial susceptibility data. The app will be built upon the existing recommendations from the Division of Infectious Diseases, Department of Clinical Pharmacy, and Clinical Microbiology Laboratory contained in the IDMP. We anticipate that this free application will be widely adopted by prescribers with iOS devices at UCSF.

Impact on UCSF's Mission:

· Improves quality of care by informing antimicrobial selection and dosing, and facilitating timely prescribing of antimicrobials

· Reduces adverse events by minimizing inappropriate dosing of antimicrobials

· Improves physician productivity by decreasing time spent identifying the appropriate antimicrobial regimen, dosing, and frequency

· Improves productivity of pharmacists, nurses, and support staff by minimizing inappropriate orders

· Decreases cost of care via each of the above effects

Team Member and Project Role:

Matt Cascino, MD App developer/Programmer/Tester (80 hours)

Alvin Rajkomar, MD App developer/Programmer/Tester (80 hours)

Conan MacDougall, PharmD Subject Matter Expert (5 hours)

Brad Monash, MD Visionary (20 hours)