Senn 2004.

Methods	STUDY DESIGN: RCT Risk of bias: MEDIUM
Participants	PROVIDERS: residents on medical and surgical wards PATIENTS: 251 patients were recruited, 126 intervention and 125 control CLINICAL PROBLEM: adult patients receiving IV antibiotics for 3 to 4 days with no modification since starting treatment SETTING: single 800‐bed university hospital in Switzerland. Data collected over 5 months. POWER CALCULATION: yes, 135 patients in each group, but the trial was underpowered because the observed effect was lower than predicted. Details in Appendix 3
Interventions	FORMAT: Interventions: dissemination of questionnaire about guidelines; reminders (circumstantial and physical, questionnaire mailed to the resident in charge of patients who were receiving IV antibiotic treatment. The questionnaire asked 3 questions regarding possible adaptation of antibiotic therapy on day 3 or 4, and was collected 24 hours later. If the resident had not yet completed it at that time, he/she was reminded once to do so.) Intervention Functions: education, enablement, environmental restructuring DELIVERER: AMT COMPARISON: control patients with no intervention DESIRED CHANGE: reduction in established management (reduction in duration of IV therapy) TIMING: intervention at the point of decision making (potential modification 3 to 4 days after start of antibiotics)
Outcomes	PRESCRIBING: Choice: % of patients discontinuing IV antibiotics and hazard ratio adjusted for patients' Karnofsky functional index
Notes	FINANCIAL SUPPORT: Funding: Quality Improvement Committee of the Lausanne University Hospital and grant 32–63128.00 of the Swiss National Science Foundation. Competing Interests: no information ADDITIONAL DATA: no response from authors to request for additional data
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Patients allocated ... by using a computer generated randomizations list"
Allocation concealment (selection bias)	Low risk	"Concealment of allocation was achieved as the physician in charge of the patient was involved after randomizations"
Blinding (performance bias and detection bias) All outcomes	High risk	"This was a randomised, controlled, open trial"
Incomplete outcome data (attrition bias) All outcomes	Low risk	Primary outcome measure (duration of IV antibiotics) collected on all patients. Only 70% of questionnaires returned for the intervention group, which could account for the intervention effect being lower than expected. However, this did not affect outcome assessment.
Selective reporting (reporting bias)	Low risk	Complete primary outcome data
Other bias	High risk	The study was underpowered.
Baseline Outcomes similar?	Low risk	Pre‐study group, data collected for 2 months before intervention to estimate the magnitude of possible observation bias (Figure 2).
Free of contamination?	Low risk	The pre‐intervention group data were comparable to the control group, suggesting minimal observation bias.
Baseline characteristics similar?	Low risk	Presented in Table 1