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

Abstract

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.

SHEA statement on antibiotic stewardship in hospitals during public health emergencies

“…ASPs can adapt their communication strategies during a pandemic (eg, virtual rounds) and work with hospital leadership on optimal strategies for dissemination of new information. Development of clinical guidelines can be shared onsite, and through health system networks and telemedicine, 97 providing similar benefits to smaller hospitals with less on-site expertise. Importantly, ASPs can frame inappropriate antibiotic prescribing as a low-value intervention and engage HCP in shared decision making.…”

Use of virtual care by infectious disease specialists in Canada: A national survey

“…As the use of virtual care becomes an accepted modality in healthcare, physicians will need to ensure proficiency in skills unique to virtual care. A framework of telehealth skills has been developed by the Association of American Medical Colleges, 4 and incorporation of these elements into residency training curricula 5 will be essential to ensure current and future physicians are competent in providing virtual care upon entering independent practice. The use of case vignettes in our study provides a glimpse into the major clinical factors that shape a clinician's decision to provide virtual versus in-person care.…”

Effect of tele‐COVID rounds and a tele‐stewardship intervention on antibiotic use in COVID‐19 patients admitted to 17 small community hospitals

“…Tele‐ID physicians provide telephone advice and perform remote ID consultations for inpatients through two‐way audio/visual technology. This intervention expanded upon this existing tele‐ID and teleASP infrastructure, further described previously 9 …”

“…Despite low rates of bacterial co‐infection in patients hospitalized with COVID‐19, antibiotics are commonly prescribed 1–5 . Antibiotic stewardship interventions for COVID‐19 have been described in large academic medical centers, but small community hospitals (SCHs) often lack the resources and infectious diseases (IDs) expertise to implement such initiatives 6–9 . Herein, we describe a novel telehealth intervention of multidisciplinary COVID rounds (tele‐COVID rounds) that were augmented with tele‐antibiotic stewardship (teleASP) surveillance to optimize antibiotic prescribing in patients with COVID‐19 who were admitted to 17 SCHs in the Intermountain Healthcare system.…”