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

• Published in: Clinical infectious diseases 2020-07, Vol.71 (3), p.539-545
• Main Authors: Shively, Nathan R, Moffa, Matthew A, Paul, Kathleen T, Wodusky, Eric J, Schipani, Beth Ann, Cuccaro, Susan L, Harmanos, Mark S, Cratty, Michael S, Chamovitz, Bruce N, Walsh, Thomas L
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antimicrobial Stewardship; Hospitals, Community; Humans; Pharmacists; Telemedicine
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciz878

Abstract Background Data on antimicrobial stewardship programs (ASPs) facilitated via telehealth in the community hospital setting are limited. Methods A telehealth-based ASP was implemented in 2 community hospitals (285 and 176 beds). Local pharmacists without residency or prior antimicrobial stewardship training were trained to conduct prospective audit and feedback. For approximately 60 minutes 3 times weekly at the 285-bed hospital and 2 times weekly at the 176-bed hospital, infectious diseases (ID) physicians remotely reviewed patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft tissue infections with local pharmacists. Recommendations for ASP interventions made by ID physicians were relayed to primary teams and tracked by local pharmacists. Antimicrobial utilization was collected in days of therapy (DOT) per 1000 patient-days (PD) for a 12-month baseline and 6-month intervention period, and analyzed with segmented linear regression analysis. Local ID consultations were tracked and antimicrobial cost savings were estimated. Results During the 6-month intervention period, 1419 recommendations were made, of which 1262 (88.9%) were accepted. Compared to the baseline period, broad-spectrum antibiotic utilization decreased by 24.4% (342.1 vs 258.7 DOT/1000 PD; P < .001) during the intervention period. ID consultations increased by 40.2% (15.4 consultations per 1000 PD vs 21.5 consultations per 1000 PD; P = .001). Estimated annualized savings on antimicrobial expenditures were $142 629.83. Conclusions An intense ASP model, facilitated in the community hospital setting via telehealth, led to reduced broad-spectrum antimicrobial utilization, increased ID consultations, and reduced antimicrobial expenditures. We describe the implementation of a telehealth-based antimicrobial stewardship program in 2 community hospitals with local pharmacy and remote infectious diseases (ID) physician support. This strategy was associated with reduced antibiotic utilization, increased local ID consultations, and reduced antimicrobial expenditures.