A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers

Stevenson, Lauren; Banks, Richard; Stryczek, Krysttel C; Crnich, Christopher; Ide, Emma; Wilson, Brigid; Viau, Roberto; Ball, Sherry L.; Jump, Robin L.P.

doi:10.1017/ice.2018.197

Cited by 27 publications

(21 citation statements)

References 15 publications

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“…Infection prevention resources could be made available in lower complexity and entirely ambulatory centers through educational, telemedicine and policy sharing initiatives. Underscoring the potential for a telehealth solution, a promising recent VA pilot study demonstrated the feasibility and effectiveness of a telemedicine-based antimicrobial stewardship program for expanding these programs to rural health centers that have minimal ancillary support services [28]. In addition, measures to include existing staff in these facilities, such as incorporating local clinical pharmacists for antimicrobial stewardship interventions, may be another important approach to improve care without requiring additional hiring, which may present logistical and financial challenges for some centers, particularly those serving rural areas.…”

Section: Discussionmentioning

confidence: 99%

Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Branch‐Elliman

Pizer

Dasinger

et al. 2019

Antimicrob Resist Infect Control

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Background Guidelines recommend discontinuation of antimicrobial prophylaxis within 24 h after incision closure in uninfected patients. However, how facility and surgical specialty factors affect the implementation of these evidence-based surgical prophylaxis guidelines in outpatient surgery is unknown. Thus, we sought to measure how facility complexity, including ambulatory surgical center (ASC) status and availability of ancillary services, impact adherence to guidelines for timely discontinuation of antimicrobial prophylaxis after outpatient surgery. A secondary aim was to measure the association between surgical specialty and guideline compliance. Methods A multi-center, national Veterans Health Administration retrospective cohort from 10/1/2015–9/30/2017 including any Veteran undergoing an outpatient surgical procedure in any of five specialties (general surgery, urology, ophthalmology, ENT, orthopedics) was created. The primary outcome was the association between facility complexity and proportion of surgeries not compliant with discontinuation of antimicrobials within 24 h of incision closure. Data were analyzed using logistic regression with adjustments for patient and procedural factors. Results Among 153,097 outpatient surgeries, 7712 (5.0%) received antimicrobial prophylaxis lasting > 24 h after surgery; rates ranged from 0.4% (eye surgeries) to 13.7% (genitourinary surgeries). Cystoscopies and cystoureteroscopy with lithotripsy procedures had the highest rates (16 and 20%), while hernia repair, cataract surgeries, and laparoscopic cholecystectomies had the lowest (0.2–0.3%). In an adjusted logistic regression model, lower complexity ASC and hospital outpatient departments had higher odds of prolonged antimicrobial prophylaxis compared to complex hospitals (OR ASC, 1.3, 95% CI: 1.2–1.5). Patient factors associated with higher odds of noncompliance with antimicrobial discontinuation included younger age, female sex, and white race. Genitourinary and ear/nose/throat surgeries were associated with the highest odds of prolonged antimicrobial prophylaxis. Conclusions Facility complexity appears to play a role in adherence to surgical infection prevention guidelines. Lower complexity facilities with limited infection prevention and antimicrobial stewardship resources may be important targets for quality improvement. Such interventions may be especially useful for genitourinary and ear/nose/throat surgical subspecialties. Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ambulatory surgery centers and hospital outpatient departments in their efforts to improve this facet of patient safety. Electronic supplementary material The online version of this article (10.1186/s13756-019-0503-9) contains supplementary material, which is available to authorized users. ...

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Section: Discussionmentioning

confidence: 99%

Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Branch‐Elliman

Pizer

Dasinger

et al. 2019

Antimicrob Resist Infect Control

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“…Finally, the implementation of the VAST differed between sites A and B, with each team making adaptations to suit their system and culture. 4 This pilot project was not designed to test for the relative influences of differences in implementation; further investigation is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…A multidisciplinary team from each intervention site paired with an off-site infectious disease physician from another VAMC for weekly 1-hour telehealth sessions to discuss concerns related to infections and antimicrobial use among patients at the intervention site. 4 For site A (27 acute-care beds with limited capacity for ventilated patients; 162 long-term care beds), the VAST formed in August 2016. For site B (10 acute-care beds with no capacity for ventilated patient; 180 long-term care beds), the VAST formed in October 2016.…”

Section: Interventionmentioning

confidence: 99%

“…2,3 Previously, we described a pilot program that used telehealth to support antibiotic stewardship efforts at 2 rural Veterans Affairs medical centers (VAMCs). 4 The pilot program leveraged SCAN-ECHO infrastructure and equipment to connect pharmacists, infection preventionists, staff nurses, and other clinicians at a rural VAMC with infectious disease physicians at a geographically distant VA to form a videoconference antimicrobial stewardship team (VAST) that com-bined tele-consultation and tele-stewardship approaches. Here, we describe changes in antibiotic use on the acute and long-term care units at the intervention sites following implementation of the VAST.…”

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confidence: 99%

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Changes in antibiotic use following implementation of a telehealth stewardship pilot program

Wilson

Banks

Crnich

et al. 2019

Infect. Control Hosp. Epidemiol.

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“…Monkowski and colleagues provided ID telemedicine consults, while Tande and colleagues provided asynchronous ID eConsult for remote hospitals, but neither described an integrated ASP component [ 9 , 10 ]. Stevenson and colleagues used a weekly videoconference to support antibiotic stewardship efforts at 2 rural facilities [ 11 ]. In a more integrated model, Laible and colleagues established an ASP across a rural health system through a daily call where local pharmacists identified and presented cases [ 12 ].…”

mentioning

confidence: 99%

Implementation of an Infectious Diseases Telehealth Consultation and Antibiotic Stewardship Program for 16 Small Community Hospitals

Vento

Veillette

Gelman

et al. 2021

Open Forum Infectious Diseases

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Background Telehealth improves access to infectious diseases (ID) and antibiotic stewardship (AS) services in small community hospitals (SCHs), but the optimal model has not been defined. We describe implementation and impact of an integrated ID telehealth (IDt) service for 16 SCHs in the Intermountain Healthcare system. Methods The Intermountain IDt service included a 24-hour advice line, eConsults, telemedicine consultations (TCs), daily AS surveillance, long-term AS program (ASP) support by an IDt pharmacist, and a monthly telementoring webinar. We evaluated program measures from November 2016 through April 2018. Results A total of 2487 IDt physician interactions with SCHs were recorded: 859 phone calls (35% of interactions), 761 eConsults (30%), and 867 TCs (35%). Of 1628 eConsults and TCs, 1400 (86%) were SCH provider requests, while 228 (14%) were IDt pharmacist generated. Six SCHs accounted for >95% of interactions. Median consultation times for each initial telehealth interaction type were 5 (interquartile range [IQR], 5–10) minutes for phone calls, 20 (IQR, 15–25) minutes for eConsults, and 50 (IQR, 35–60) minutes for TCs. Thirty-two percent of consults led to in-person ID clinic follow-up. Bacteremia was the most common reason for consultation (764/2487 [31%]) and Staphylococcus aureus the most common organism identified. ASPs were established at 16 facilities. Daily AS surveillance led to 2229 SCH pharmacist and 1305 IDt pharmacist recommendations. Eight projects were completed with IDt pharmacist support, leading to significant reductions in meropenem, vancomycin, and fluoroquinolone use. Conclusions An integrated IDt model led to collaborative ID/ASP interventions and improvements in antibiotic use at 16 SCHs. These findings provide insight into clinical and logistical considerations for IDt program implementation.

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A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers

Abstract: This pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.

Cited by 27 publications

References 15 publications

Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Changes in antibiotic use following implementation of a telehealth stewardship pilot program

Implementation of an Infectious Diseases Telehealth Consultation and Antibiotic Stewardship Program for 16 Small Community Hospitals

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