1407. Impact of 2-hours/day of intensive weekend antimicrobial stewardship coverage
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Background: Antimicrobial stewardship (AST) programs are increasingly common.  Due to staffing limitations, academic centers often rely on clinical Infectious Diseases (ID) fellows for some coverage of their AST.  In an effort to strengthen AST practice on the weekend days and to reduce the workload for first-year fellows, we launched a two hour per weekend morning moonlighting shift for senior ID fellows and ID-trained PharmDs.  We sought to identify the impact of this AST intervention.

Methods: A multi-pronged educational AST component was started for infectious disease fellows to complement the optional moonlighting in an AST roles on the weekends.  Data were extracted from electronic records during Feb 1st through April 30th 2014, the year prior to implementation and the same 3 months (after a 2-month wash-in) in 2015. Patients from obstetrics, psychiatry and neonatology floors were excluded.  Demographic, clinical, and medication data were abstracted from the medical record.  Comparisons between the two periods were made using calculations incorporating case-mix index, total number of patients and patient days.  

Results: 294 patients required AST review during the three month period in 2014 and 343 patients in 2015.  For this group, the number of patient days of therapy per 1000 were 27.87 for 2014 and 32.56 for 2015.  Case mix index was lower for the three month period of 2014 at 1.57 and 1.61 for 2015. The median time to approval was 59 minutes in the pre-intervention period and 61 minutes after. Documentation of stewardship interventions during these off hours increased from zero in 2014 to 248 in 2015, and the total number of interventions increased by a similar increment.

Conclusion: A focused intervention on off-peak times such as weekends may have an impact on choice and duration of antibiotics.  In our single center study, offering an additional AST-focused shift to infectious disease fellows was associated with increased interventions. Anecdotally, first year fellows reported substantial improvement in their weekend workflow and educational experience after the intervention.

Payal K. Patel, MD, Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, Christopher McCoy, PharmD, BCPS, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA and Howard S. Gold, MD, FIDSA, Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA


P. K. Patel, None

C. McCoy, Actavis: Grant Investigator , Grant recipient and Research grant

H. S. Gold, None

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