Impact of a Telehealth-Based Antimicrobial Stewardship Program in a Community Hospital Health System

Shively, Nathan R; Moffa, Matthew; Paul, K; Wodusky, Eric J; Schipani, Beth Ann; Cuccaro, Susan L; Harmanos, Mark S; Cratty, Michael S; Chamovitz, Bruce N; Walsh, Thomas

doi:10.1093/cid/ciz878

Cited by 30 publications

(28 citation statements)

References 29 publications

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“…These findings suggest that the active involvement of ID specialists, even if not on-site, can be an effective approach to stewardship. Other smaller non-randomized studies have found that the involvement of remote ID specialists in stewardship activities can reduce antibiotic use [9][10][11]23]. All non-ID sites in our study's cohort reported communicating with off-site ID specialists, but only one of the sites identified an offsite ID specialist as their stewardship champion.…”

Section: Discussionmentioning

confidence: 56%

Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

Livorsi

Nair

Lund

et al. 2020

Clinical Infectious Diseases

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Background Many US hospitals lack infectious disease (ID) specialists, which may hinder antibiotic stewardship efforts. We sought to compare patient-level antibiotic exposure at Veterans Health Administration (VHA) hospitals with and without an on-site ID specialist, defined as an ID physician and/or ID pharmacist. Methods This retrospective VHA cohort included all acute-care patient admissions during 2016. A mandatory survey was used to identify hospitals’ antibiotic stewardship processes and their access to an on-site ID specialist. Antibiotic use was quantified as days of therapy per days present and categorized based on National Healthcare Safety Network definitions. A negative binomial regression model with risk adjustment was used to determine the association between presence of an on-site ID specialist and antibiotic use at the level of patient admissions. Results Eighteen of 122 (14.8%) hospitals lacked an on-site ID specialist; there were 525 451 (95.8%) admissions at ID hospitals and 23 007 (4.2%) at non-ID sites. In the adjusted analysis, presence of an ID specialist was associated with lower total inpatient antibacterial use (odds ratio, 0.92; 95% confidence interval, .85–.99). Presence of an ID specialist was also associated with lower use of broad-spectrum antibacterials (0.61; .54–.70) and higher narrow-spectrum β-lactam use (1.43; 1.22–1.67). Total antibacterial exposure (inpatient plus postdischarge) was lower among patients at ID versus non-ID sites (0.92; .86–.99). Conclusions Patients at hospitals with an ID specialist received antibiotics in a way more consistent with stewardship principles. The presence of an ID specialist may be important to effective antibiotic stewardship.

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Section: Discussionmentioning

confidence: 56%

Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

Livorsi

Nair

Lund

et al. 2020

Clinical Infectious Diseases

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“…8 For hospitalized patients there are numerous reports of using telehealth for rapid evaluation for intensive care and subspecialty consults such as dermatology, infectious diseases, and psychiatry, where a thorough chart review, history, and visual exam may provide consultants with sufficient information to make clinical recommendations. [9][10][11][12][13][14][15][16][17][18] Telehealth has also been used to engage patients and families in their care during and after hospitalization. [19][20][21] One major limitation to the widespread adoption of telehealth initiatives has been the lack of payment models 22 however, in response to the COVID-19 pandemic both federal and state governments have loosened restrictions on privacy and billing for telehealth visits in an effort to allow health care providers to continue to care for patients while reducing potential exposure to the virus.…”

Section: Background and Significancementioning

confidence: 99%

Rapid Implementation of an Inpatient Telehealth Program during the COVID-19 Pandemic

et al. 2020

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Abstract Background Relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic provide expanded opportunities to use telehealth to provide patient care at a distance. Many health systems have transitioned to providing outpatient care via telehealth; however, there is an opportunity to utilize telehealth for inpatients to promote physical distancing. Objective This article evaluates the use of a rapidly implemented, secure inpatient telehealth program. Methods We assembled a multidisciplinary team to rapidly design, implement, and iteratively improve an inpatient telehealth quality improvement initiative using an existing videoconferencing system at our academic medical center. We assigned each hospital bed space a unique meeting link and updated the meeting password for each new patient. Patients and families were encouraged to use their own mobile devices to join meetings when possible. Results Within 7 weeks of go-live, we hosted 1,820 inpatient telehealth sessions (13.3 sessions per 100 bedded days). We logged 104,647 minutes of inpatient telehealth time with a median session duration of 22 minutes (range 1–1,961). There were 5,288 participant devices used with a mean of 3 devices per telehealth session (range 2–22). Clinicians found they were able to build rapport and perform a reasonable physical exam. Conclusion We successfully implemented and scaled a secure inpatient telehealth program using an existing videoconferencing system in less than 1 week. Our implementation provided an intuitive naming convention for providers and capitalized on the broad availability of smartphones and tablets. Initial comments from clinicians suggest the system was useful; however, further work is needed to streamline initial setup for patients and families as well as care coordination to support clinician communication and workflows. Numerous use cases identified suggest a role for inpatient telehealth will remain after the COVID-19 crisis underscoring the importance of lasting regulatory reform.

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“…A different remote ASP model described by Shively and colleagues wherein ID physicians provided antimicrobial stewardship services via telehealth to two community hospitals also reported similar acceptance rates (88.9%); however, they found statistically significant reductions in antimicrobial use (342.1 vs. 258.7 DOT/1000 PD, p < 0.001) [12].…”

Section: Discussionmentioning

confidence: 75%

Effects of a Remote Antimicrobial Stewardship Program on Antimicrobial Use in a Regional Hospital System

Knight¹,

Michal²,

Milliken³

et al. 2020

Pharmacy

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While antimicrobial stewardship programs (ASPs) are well established at most large medical centers, small or rural facilities often do not have the same resources; therefore, different methods must be developed to start or expand ASPs for these hospitals. The purpose of this quality improvement study was to describe the implementation of a pharmacist-led remote ASP and assess the effect on antimicrobial use. Antimicrobial use in days of therapy per 1000 patient days (DOT/1000 PD) was compared between the six months before and after remote ASP implementation. Changes in system-wide, facility-specific, and target antimicrobial use were evaluated. Pharmacist interventions, acceptance rates, and number of times infectious disease (ID) physician assistance was sought were also tracked. System-wide antimicrobial use was 4.6% less in the post-implementation time period than in the pre-implementation time period, with vancomycin, piperacillin/tazobactam, and fluoroquinolones having the greatest reductions in use. Ninety-one percent of interventions made during the post-implementation period were accepted. ID physician review was requested 38 times, and direct ID physician intervention was required six times. Remote ASPs delivered from a central facility to serve a larger system may reduce antimicrobial use, especially against targeted agents, with minimal increase in ID physician workload.

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Impact of a Telehealth-Based Antimicrobial Stewardship Program in a Community Hospital Health System

Cited by 30 publications

References 29 publications

Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

Rapid Implementation of an Inpatient Telehealth Program during the COVID-19 Pandemic

Effects of a Remote Antimicrobial Stewardship Program on Antimicrobial Use in a Regional Hospital System

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