Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention

2016 ◽  
Vol 38 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Jennifer Dela-Pena ◽  
Luiza Kerstenetzky ◽  
Lucas Schulz ◽  
Ron Kendall ◽  
Alexander Lepak ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Effective ◽  
Transitions Of Care ◽  
Medical Chart Review ◽  
Antimicrobial Utilization ◽  
Therapy Cost ◽  
Cost Per Admission

OBJECTIVETo characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization.DESIGNRetrospective cohort study.PATIENTSTop 1% of the antimicrobial budget from July 1 through December 31, 2014.METHODSPatients were identified through a pharmacy billing database. Baseline characteristics were collected through a retrospective medical chart review. Patients were presented to the antimicrobial stewardship team to determine appropriate utilization of high-cost antimicrobials and potential intervention opportunities. Appropriate use was defined as antimicrobial therapy that was effective, safe, and most cost-effective compared with alternative agents.RESULTSA total of 10,460 patients received antimicrobials in 6 months; 106 patients accounted for $889,543 (47.2%) of the antimicrobial budget with an antimicrobial cost per day of $219±$192 and antimicrobial cost per admission of $4,733±$7,614. Most patients were immunocompromised (75%) and were followed by the infectious disease consult service (80%). The most commonly prescribed antimicrobials for treatment were daptomycin, micafungin, liposomal amphotericin B, and meropenem. Posaconazole and valganciclovir accounted for most of the prophylactic therapy. Cost-effective opportunities (n=71) were present in 57 (54%) of 106 patients, which included dose optimization, de-escalation, dosage form conversion, and improvement in transitions of care.CONCLUSIONAntimicrobial stewardship oversight is important in implementing cost-effective strategies, especially in complex and immunocompromised patients who require the use of high-cost antimicrobials.Infect Control Hosp Epidemiol 2017;38:259–265

Implementation of telehealth antimicrobial stewardship through partnership of an academic medical center and a community hospital

2021 ◽  
Author(s):  
Megan E Klatt ◽  
Lucas T Schulz ◽  
Dan Fleischman ◽  
Barry C Fox ◽  
Stuart Burke ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Length Of Stay ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Community ◽  
Antimicrobial Utilization ◽  
Academic Medical ◽  
Tract Infections

Abstract Purpose Small community hospitals often lack the human, financial, and technological resources necessary to implement and maintain successful antimicrobial stewardship programs now required by national regulatory and accrediting bodies. Creative solutions are needed to address this problem. Summary A 3-stage, quasi-experimental study including patients receiving antibiotics for pneumonia, skin and soft tissue infections, and urinary tract infections at a community hospital in Wisconsin from June 2013 to December 2015 was conducted. Remote telehealth prospective audit and feedback, guideline and order set management, and staff education targeting pharmacists, nurses, and physicians were provided during the 7-month intervention phase; these services were then removed for the postintervention period. Antimicrobial utilization (days of therapy [DOT] per 1,000 patient-days), hospital length of stay, and readmission and 30-day mortality rates were assessed to determine the impact of telehealth services on these outcomes. During the preintervention (baseline), intervention, and postintervention periods, 1,037 patients received antibiotics for the targeted infectious disease conditions. Patient demographics and rates of infectious disease conditions were similar among the different periods. Telehealth antimicrobial stewardship reduced broad-spectrum antibiotic use, including use of imipenem (from 83 to 31 DOT, P < 0.001), levofloxacin (from 123 to 99 DOT, P < 0.001), and vancomycin (from 104 to 85 DOT, P < 0.001), compared to utilization during the baseline period; mean (SD) length of stay also decreased (from 4.6 [2.8] days to 4.2 [2.6] days, P = 0.02). After nonrenewal of telehealth stewardship, vancomycin and piperacillin/tazobactam usage returned to or exceeded baseline levels. Conclusion The partnership between an academic medical center and a small community hospital improved antimicrobial utilization and clinical outcomes. Successful telehealth antimicrobial stewardship models should be explored further as a means to provide optimal patient care.

scholarly journals 164. Avoiding Complacency: Assessing the Perceived Impact and Value of Antimicrobial Stewardship at a Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S90-S91
Author(s):  
Matthew S Lee ◽  
Christopher McCoy
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Team Members ◽  
Academic Medical ◽  
Support Tools ◽  
Educational Engagement ◽  
Similar Survey ◽  
Perceived Impact

Abstract Background Multi-disciplinary engagement and education remain key measures for Antimicrobial Stewardship Programs (ASPs). Over 3 years, our ASP has undergone key changes to pre-authorization review, post-prescriptive activities, and core team members, coinciding with a 30% increase in stewardship interventions. The objectives of this study were to evaluate the familiarity of Nursing, Pharmacy and Prescribers at our academic medical center regarding ASP activities and services, as well as perceived impact on patient care and value. Secondary objectives were to determine what resources are currently utilized and areas for improvement. Methods Distinct surveys were distributed to three participant groups: Nurses, Pharmacists, and Prescribers (Housestaff, Advanced Practice Providers, and staff physicians). Questions were developed to assess familiarity, perceived value, and overall satisfaction with the ASP. Additional items included questions on the current use of ASP resources and educational engagement. Survey results were compared to a similar survey conducted 3 years amongst the same participant groups. Results The survey was delivered electronically to 3367 Prescribers, Nurses and Pharmacists. 403 responders completed the survey (208 Nurses, 181 Prescribers, and 18 Pharmacists). Familiarity was lowest amongst Nurses, but almost doubled compared to 2016 (Figure). Prescribers cited “restricted antibiotic approval”, “de-escalation”, and “alternative therapies relative to allergies” as the three most common interaction types, similar to 2016. ASP interactions continued to be rated “moderate” or “high” value (88.4% vs 89.15% in 2016), however, face-to-face interactions were preferred by only 4% of responders (unchanged compared to 2016). Prescribers also responded uncommon use of ASP online resources (20%) and clinical decision support tools (34%). 78% of responders expressed desire for increased ASP-related education. Conclusion As ASPs evolve, it is important to constantly evaluate impact and value, and identify areas for growth. Despite ASP familiarity being high and interactions valued, we need to further optimize ASP provided resources, clinical support tools, and educational offerings. Disclosures All Authors: No reported disclosures

scholarly journals Implementation of a Resource-Efficient Indirect Handshake Stewardship Model at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s272-s272
Author(s):  
Ronald Beaulieu ◽  
Milner Staub ◽  
Thomas Talbot ◽  
Matthew Greene ◽  
Gowri Satyanarayana ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Antibiotic Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Communication Model ◽  
Contributing Factors ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Data Feedback ◽  
Days Of Therapy

Background: Handshake antibiotic stewardship is an effective but resource-intensive strategy for reducing antimicrobial utilization. At larger hospitals, widespread implementation of direct handshake rounds may be constrained by available resources. To optimize resource utilization and mirror handshake antimicrobial stewardship, we designed an indirect feedback model utilizing existing team pharmacy infrastructure. Methods: The antibiotic stewardship program (ASP) utilized the plan-do-study-act (PDSA) improvement methodology to implement an antibiotic stewardship intervention centered on antimicrobial utilization feedback and patient-level recommendations to optimize antimicrobial utilization. The intervention included team-based antimicrobial utilization dashboard development, biweekly antimicrobial utilization data feedback of total antimicrobial utilization and select drug-specific antimicrobial utilization, and twice weekly individualized review by ASP staff of all patients admitted to the 5 hospitalist teams on antimicrobials with recommendations (discontinuation, optimization, etc) relayed electronically to team-based pharmacists. Pharmacists were to communicate recommendations as an indirect surrogate for handshake antibiotic stewardship. As reviewer duties expanded to include a rotation of multiple reviewers, a standard operating procedure was created. A closed-loop communication model was developed to ensure pharmacist feedback receipt and to allow intervention acceptance tracking. During implementation optimization, a team pharmacist-champion was identified and addressed communication lapses. An outcome measure of days of therapy per 1,000 patient days present (DOT/1,000 PD) and balance measure of in-hospital mortality were chosen. Implementation began April 5, 2019, and data were collected through October 31, 2019. Preintervention comparison data spanned December 2017 to April 2019. Results: Overall, 1,119 cases were reviewed by the ASP, of whom 255 (22.8%) received feedback. In total, 236 of 362 recommendations (65.2%) were implemented (Fig. 1). Antimicrobial discontinuation was the most frequent (147 of 362, 40.6%), and most consistently implemented (111 of 147, 75.3%), recommendation. The DOT/1,000 PD before the intervention compared to the same metric after intervention remained unchanged (741.1 vs 725.4; P = .60) as did crude in-hospital mortality (1.8% vs 1.7%; P = .76). Several contributing factors were identified: communication lapses (eg, emails not received by 2 pharmacists), intervention timing (mismatch of recommendation and rounding window), and individual culture (some pharmacists with reduced buy-in selectively relayed recommendations). Conclusion: Although resource efficient, this model of indirect handshake did not significantly impact total antimicrobial utilization. Through serial PDSA cycles, implementation barriers were identified that can be addressed to improve the feedback process. Communication, expectation management, and interpersonal relationship development emerged as critical issues contributing to poor recommendation adherence. Future PDSA cycles will focus on streamlining processes to improve communication among stakeholders.Funding: NoneDisclosures: None

Role of postgraduate year 2 pharmacy residents in providing weekend antimicrobial stewardship coverage in an academic medical center

2017 ◽  
Vol 74 (6) ◽  
pp. 417-423 ◽  
Author(s):  
Justin Siegfried ◽  
Cristian Merchan ◽  
Marco R. Scipione ◽  
John Papadopoulos ◽  
Arash Dabestani ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical
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