Clinical Impact of an Antimicrobial Stewardship Program on Pediatric Hospitalist Practice, a 5-year Retrospective Analysis
Background: Antimicrobial stewardship programs (ASPs) and the field of hospital medicine are both intended to improve resource use and health outcomes for hospitalized patients. Understanding how these clinical services interact in the hospital setting can inform practice improvement strategies. The objectives of this study were to identify clinical factors associated with ASP intervention among children treated by hospitalists and to determine the impact of ASP interventions on clinical outcomes of children managed by hospitalists.
Methods: This retrospective analysis included ASP reviews of hospitalist patients from a children's hospital system from March 2008 to June 2013. Patient demographics, clinical history, and primary diagnosis were analyzed for association with probability of ASP intervention. Length of hospital stay (LOS) and 30-day readmission were compared between cases of agreement with ASP recommendations and cases of disagreement.
Results: ASP reviewed 2251 hospitalist patients; 356 interventions were made (16% of reviews), and hospitalists agreed with ASP recommendations in 296 cases (87%). The probability of ASP intervention among hospitalist patients decreased during the study period (19% Year 1 vs 10% Year 5, p<0.0001). Ceftriaxone was the most common antibiotic (270/356, 70%) and community-acquired pneumonia was the most common diagnosis (114/356, 32%) associated with ASP intervention. Presence of a co-morbid complex medical condition and infection type were not associated with ASP intervention. The most commonly-recommended intervention was to stop antibiotic therapy; ID consultation had the highest rate of disagreement (Figure 1). There were no differences in LOS or 30-day readmission between cases where hospitalists disagreed with ASP recommendations versus cases when recommendations were followed.
Conclusion: The likelihood of ASP interventions in hospitalist patients decreased over time, suggesting a change in prescribing behavior. Hospitalists usually complied with ASP recommendations, but disagreement was not associated with longer LOS or readmission. These data suggest ASPs and hospitalists are regularly engaged in facilitating a variety of antimicrobial prescribing decisions.
B. Lee, None
D. Yu, None
L. Stach, None
J. Goldman, None
A. Myers, None
J. Day, None
B. Pate, None
J. Newland, Pfizer: Grant Investigator, Grant recipient