Impact of Hospitalist-Led Interdisciplinary Antimicrobial Stewardship Interventions at an Academic Medical Center

Tang, Stephanie; Gupta, Renuka; Lee, Jennifer I.; Majid, Adrian; Patel, Paresh K.; Efird, Leigh; Loo, Angela; Mazur, Shawn; Calfee, David P.; Archambault, Alexi; Jannat‐Khah, Deanna; Dargar, Savira Kochhar; Simon, Matthew S.

doi:10.1016/j.jcjq.2018.09.002

Cited by 11 publications

(7 citation statements)

References 16 publications

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“…One study on a surgical co-management model, which mainly focused on patients that required surgery, found a signi cant reduction in the ICU admission rate in the hospitalist group [35], compared to the non-hospitalist group. Other studies have reported no signi cant difference the ICU admission rates between the two types of care [36][37][38]. However, in our study, the ICU admission rate decreased signi cantly with AMU hospitalist care.…”

Section: Discussioncontrasting

confidence: 83%

Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

Kim¹,

J²,

Jh³

et al. 2020

Preprint

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BACKGROUND: The present study aimed to assess a newly introduced, hospitalist-run, acute medical unit (AMU) model in Korea. The AMU in our institution started in October 2015. Four hospitalists managed patients with acute medical needs that were admitted through the emergency department (ED). STUDY DESIGN: We conducted a retrospective cohort study of all medical inpatients admitted through the ED from June 1, 2016 to May 31, 2017, at a tertiary care hospital. We evaluated 6391 patients whether the hospitalist care in the AMU improved patient outcomes compared to standard non-hospitalist care. METHODS: We created multivariate analysis models to compare the clinical outcomes of patients cared for by hospitalists with the outcomes of patients cared for by non-hospitalists. RESULTS: In the adjusted models, compared to the non-hospitalist group, the AMU hospitalist group had a lower in-hospital mortality (OR: 0.46, P <0.001), a lower intensive care unit (ICU) admission rate (OR: 0.39, P <0 .001), a shorter hospital length of stay (coefficient: -1.349, SE: 0.217; P <0.001), and a shorter ED waiting time (coefficient: -3.021, SE: 0.256; P <0.001). There were no significant differences in the 10-day or 30-day re-admission rates (P = 0.493, P = 0.201; respectively). CONCLUSIONS: The AMU hospitalist care model was associated with reductions in in-hospital mortality, ICU admission rate, length of hospital stay, and ED waiting time. These findings suggested that this AMU hospitalist care model might be adaptable to other healthcare systems to improve care for patients with acute medical needs.

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Section: Discussioncontrasting

confidence: 83%

Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

Kim¹,

J²,

Jh³

et al. 2020

Preprint

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“…The perception and understanding of antimicrobial stewardship in these groups may be an area of focus for the central ASP team going forward. Similar to a previous study, it may be essential to incorporate a bundled educational intervention to improve awareness and acceptance of ASP initiatives [6].…”

Section: Discussionmentioning

confidence: 87%

“…Rounds also facilitate a forum where bedside clinicians can engage in focused conversations of clinical strategy. Tang et al demonstrated that when compared to a non-intervention group, implementing a clinical pharmacist with stewardship training signi cantly decreased total antibiotic use by 33% [6]. Moreover, the authors acknowledged that face-to-face interactions among team members likely contributed to these reductions, which is a focus in handshake stewardship [5,6].…”

Section: Discussionmentioning

confidence: 99%

Handshake Stewardship: Interdisciplinary Rounds as a Tool to Spread Antimicrobial Stewardship Led by Hospitalist-Pharmacist Teams

Choi

Ahn

Kabir

et al. 2021

Preprint

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Background Over the past decade there has been a greater emphasis on optimizing antimicrobial stewardship. Most stewardship models rely upon a central team, often led by infectious disease doctors and pharmacists to oversee institutional prescribing. We believe there is opportunity to complement this model by incorporating stewardship into interdisciplinary rounds.ObjectiveTo access feasibility and acceptance of antimicrobial stewardship into interdisciplinary rounds.Method We piloted a stewardship model driven by hospitalists and pharmacists through interdisciplinary rounds on four medicine units. We hypothesized that our process would not hamper existing tasks of interdisciplinary rounds. We surveyed team members to understand how the initiative was experienced.ResultsMany clinicians reported that antimicrobial prescribing was ‘often’ or ‘always’ discussed, and the process was ‘not too burdensome’ to incorporate. These responses varied based on the type of provider. A majority of the advanced practice providers (88%) reported the model prompted them to reconsider their individual antimicrobial prescribing. A 28.1% overall reduction of target antibiotic utilization was realized, however, there may be other contributors to this reduction.ConclusionWe believe interdisciplinary rounds can provide a good platform to extend hospital-based antimicrobial stewardship. It was not felt to disrupt the efficiency of achieving other goals of interdisciplinary rounds.

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“…18,27,28 Our analysis suggests that physicians who are concerned with prescribing autonomy are less motivated to engage with ASP teams due to perceived restrictions of clinician autonomy. Although evidence points to the benefits of ASP models that engage physician champions 29,30 and an inclusive approach to prescribing decisions, 31 non-ASP physicians must also take accountability 32,33 to engage and recognize the crucial evidence base ASP teams provide. Although physician attitudes may present barriers to engagement in ASPs, prescribing autonomy that conflicts with evidence-based medicine should not be acceptable.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, physicians can mistrust or be skeptical of input from antibiotic stewards who are not members of the direct patient care team, 10,27,34,35 as has been reported in studies of hospitalists, 29,30,36 intensivists, 37,38 and surgeons. 39,40 In our analysis, physicians’ desire for autonomy was accompanied by a perception that ASP teams lack the full clinical picture to provide prescribing advice.…”

Section: Discussionmentioning

confidence: 99%

A qualitative evaluation of frontline clinician perspectives toward antibiotic stewardship programs

Tjilos

Drainoni

Burrowes

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: To examine the perspectives of caregivers that are not part of the antibiotic stewardship program (ASP) leadership team (eg, physicians, nurses, and clinical pharmacists), but who interact with ASPs in their role as frontline healthcare workers. Design: Qualitative semistructured interviews. Setting: The study was conducted in 2 large national healthcare systems including 7 hospitals in the Veterans’ Health Administration and 4 hospitals in Intermountain Healthcare. Participants: We interviewed 157 participants. The current analysis includes 123 nonsteward clinicians: 47 physicians, 26 pharmacists, 29 nurses, and 21 hospital leaders. Methods: Interviewers utilized a semistructured interview guide based on the Consolidated Framework for Implementation Research (CFIR), which was tailored to the participant’s role in the hospital as it related to ASPs. Qualitative analysis was conducted using a codebook based on the CFIR. Results: We identified 4 primary perspectives regarding ASPs. (1) Non-ASP pharmacists considered antibiotic stewardship activities to be a high priority despite the added burden to work duties: (2) Nurses acknowledged limited understanding of ASP activities or involvement with these programs; (3) Physicians criticized ASPs for their restrictions on clinical autonomy and questioned the ability of antibiotic stewards to make recommendations without the full clinical picture; And (4) hospital leaders expressed support for ASPs and recognized the unique challenges faced by non-ASP clinical staff. Conclusion: Further understanding these differing perspectives of ASP implementation will inform possible ways to improve ASP implementation across clinical roles.

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Impact of Hospitalist-Led Interdisciplinary Antimicrobial Stewardship Interventions at an Academic Medical Center

Cited by 11 publications

References 16 publications

Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

Handshake Stewardship: Interdisciplinary Rounds as a Tool to Spread Antimicrobial Stewardship Led by Hospitalist-Pharmacist Teams

A qualitative evaluation of frontline clinician perspectives toward antibiotic stewardship programs

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