Enhanced recovery after surgery (ERAS) may improve patients’ postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology – nephrectomy and cystectomy, spinal fusion, cardiac surgery—coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.
Rapid diagnostic technologies can assist Antimicrobial Stewardship Programs (ASPs) in achieving the goals of reducing unnecessary antimicrobial exposure and optimizing patient care. The Society of Infectious Diseases Pharmacists supports all members of the ASP team as essential components of optimal use of these technologies for management of antibiotic prescribing and cost-reduction strategies. Infect Control Hosp Epidemiol 2018;39:473-475.
Background Implementation of the Accelerate Pheno TM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSI). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing. Methods A single-center, pre-/post-intervention study of consecutive, non-duplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and allow for an assessment of the impact of discrepant RDT results with the SOC reference standard. Results Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (p < 0.001) post-intervention, and median time to IPT was reduced by 21.2 hours (p <0.001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs. POST 585.8; p = 0.043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; p <0.001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed. Conclusions While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.
Introduction The National Academy of Medicine (NAM; formerly the Institute of Medicine) recommends multidisciplinary authorship as a standard for developing trustworthy guideline panels. The purpose of this study is to describe pharmacist authorship on clinical practice guideline (CPG) expert panels. Methods Guidelines published between January 1, 2010 and December 31, 2016 and were available in the Agency for Healthcare Research and Quality National Guideline Clearinghouse database were eligible for study inclusion. Only guidelines with pharmacotherapeutic recommendations were included. The primary end point was the proportion of pharmacist authorship on national CPGs. Pharmacist authorship by specialty area and characteristics of pharmacist authors were described. Results Of the 143 guidelines included, 58 (40.6%) had at least one pharmacist author. Guidelines developed by the Veterans Affairs/Department of Defense (VA/DoD; n = 7) and the Clinical Pharmacogenetics Implementation Consortium (CPIC; n = 13) always included at least one pharmacist. Excluding VA/DoD and CPIC guidelines, the proportion of pharmacist authorship was 30.9% (38/123). A pharmacist served as the first, senior, and/or corresponding author on 19% (27/143) of CPGs. There were 1919 total authors with an average of 13.4 (+7.4) authors per guideline. Pharmacists represented 6.8% (130/1919) of all authors, and 83 were unique pharmacist authors. Critical care, emergency medicine, and adult internal medicine guidelines had the largest proportion of pharmacist authorship, while oncology and pediatric guidelines had the smallest. Pharmacy organizations sponsored or endorsed 5.2% (3/58) of CPGs with a pharmacist author. Conclusion The majority of CPGs in this cohort did not include a pharmacist in the authorship and when included, was often limited to a single pharmacist. It is imperative for pharmacy organizations to collaborate with sponsoring medical organizations and position clinical pharmacists to serve as expert members on CPGs consistent with NAM recommendations.
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