Methods: Vidant Medical Center (VMC) is a 904-bed academic medical center that has utilized the EMR to facilitate its ASP since 2007. Starting in 2011, six community hospitals (6, 20, 142, 89, 101, and 114 beds, respectively) within the Vidant Health system began ASPs, utilizing pharmacists who reviewed charts remotely from VMC. Pharmacists made recommendations within the EMR to streamline, discontinue, or switch antimicrobial agents based on clinical diagnoses and microbiology results. An infectious diseases practitioner was available for consultation and could review progress notes, laboratory values, microbiology results, and radiology studies on the EMR. Totals of charts reviewed, recommendations made, recommendations accepted, and categories of intervention were recorded. Antimicrobial consumption was measured in defined daily doses per 1000 patient days (DDD/1000 PD). Linear regression was utilized to measure changes in antimicrobial use over time.
Results: For the four larger hospitals, a mean of 83 charts per month per hospital were reviewed. Recommendations for changes were made in an average of 45 charts per month per hospital. Acceptance of the pharmacists’ recommendations varied between 80-86%. For the two smaller hospitals, an average of 10 recommendations per month were made; the acceptance rate at these hospitals was 81% and 98%, respectively. Total antimicrobial use decreased in two of the six hospitals over a 2-4 year period. Quinolone use decreased by 40-55% in four of the six hospitals over the same time period.
Conclusion: Remote antimicrobial stewardship utilizing an EMR is feasible in community hospitals and is generally received favorably by practicing physicians. As more community hospitals adopt EMRs, there is an opportunity to expand ASPs beyond the academic medical centers.
N. Nicolsen, None
P. Cook, Merck: Grant Investigator and Speaker's Bureau , Grant recipient , Research grant , Research support and Speaker honorarium
Gilead: Grant Investigator , Grant recipient and Research grant
Pfizer: Grant Investigator and Shareholder , Grant recipient and Research grant