Patel, Selina Ann; (2025) How could hospital electronic health record data be routinely harnessed to better support those responsible for antimicrobial stewardship in National Health Service hospitals in England with their work? Doctoral thesis (Ph.D), UCL (University College London).

Text Patel_Thesis.pdf - Accepted Version Access restricted to UCL open access staff until 1 September 2026. Download (12MB)

Abstract

Antimicrobial stewardship (AMS) in hospitals is essential for improving patient outcomes, and mitigating the risk of drug resistant infections to preserve antimicrobial drugs for future generations. Existing approaches for routine antimicrobial use (AMU) data collection and reporting in English hospitals are insufficiently detailed to deliver useful routine insights to inform local AMS. This thesis investigates whether, and how, to begin deriving routine metrics of hospital AMU from electronic health records (EHR), with the aim of supporting those responsible for AMS in National Health Service (NHS) hospitals in England. Chapter 1 introduces existing systems for reporting on hospital AMU in England, followed by my systematic review of different approaches to collecting data and reporting on hospital AMU in high-income settings (Chapter 2). Chapter 3 describes a Delphi I conducted to identify gaps in national AMU data collection and reporting, through engagement with professionals responsible for AMS in English hospitals. Guided by the findings of the Delphi, Chapter 4 presents a retrospective cohort study I undertook to compare 2 indicators, which are readily available in EHRs, to detect changes in patient presentation to hospital. This demonstrates how EHR data has potential to generate insights into AMU for hospitals and policymakers. Lastly, Chapters 5 and 6 describe interviews I conducted with NHS Trust Board members, exploring whether tailored metrics of AMU derived from EHRs could support boards with oversight of AMS within their trust. Even in settings where EHR datasets are available, manual approaches to collecting and analysing prescribing data to inform AMS still persist. Harnessing EHRs could support those responsible for hospital AMS with their work, but would require trusts to allocate staff and resources to establish these protocols. National policy intervention, including financial incentives, may be required to encourage trusts to prioritise this work over other areas of patient care.

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