The INSPIRE-ASP PNA Trial

• Empiric Vancomycin Use[ Time Frame: 15 month intervention ]
  Days of empiric Vancomycin treatment for pneumonia per at-risk day (first 3 days of admission). Note: this outcome is intended for the primary manuscript.
• Empiric Antipseudomonal Use[ Time Frame: 15 month intervention ]
  Days of empiric antipseudomonal antibacterial treatment for pneumonia per at-risk day (first 3 days of admission). Note: this outcome is intended for the primary manuscript.

The INSPIRE-ASP PNA trial is a cluster-randomized controlled trial of HCA hospitals comparing routine empiric antibiotic stewardship practices with real-time precision medicine computerized physician order entry smart prompts providing the probability that a non-critically ill adult admitted with PNA is infected with a resistant pathogen. Note: that enrolled "subjects" represents 59 individual HCA hospitals that have been randomized.

• Other: INSPIRE CPOE Smart Prompt
  Quality improvement intervention: computerized physician order entry (CPOE) decision support alert that provides physicians with patient-specific risk estimate of having PNA due to a multidrug resistant organism (MDRO) and recommends appropriate antibiotic choice. Continuation of other antibiotic stewardship activities in accordance with national standards.
• Other: Routine Care
  Routine Antibiotic Stewardship Arm - Continuation of all antibiotic stewardship activities in accordance with national standards.

• Active Comparator: Routine Care
  Continued routine antibiotic stewardship strategies.
• Active Comparator: INSPIRE CPOE Smart Prompt
  Use of a computerized physician order entry (CPOE) smart prompt alert to guide empiric choice of antibiotics for PNA in the first 3 days of hospitalization.