Background: Antimicrobial Stewardship Programs (ASPs) traditionally function within a single hospital staffing model. However, hospitals of variable size are integrating into large healthcare systems. ASPs must coordinate operations across multiple facilities with different stewardship requirements. We report the impact of a centralized ASP in 13 acute inpatient and rehabilitation facilities in Carolinas HealthCare System (CHS).
Methods: From 2013-2014, the CHS Antimicrobial Support Network (ASN) was implemented in 6 acute care facilities in the Charlotte, NC metro area. Program development and education was provided by a centralized team. Daily rounds (Monday-Friday) were performed by ASN trained, facility-based pharmacists, with 0.3-2 FTE per facility based on bed size. Patients were evaluated by the pharmacist if receiving target antimicrobials, ≥3 antimicrobials, or antimicrobials ≥ 72 hours. Antimicrobial use in adult inpatients was measured as days of therapy (DOT) per 1000 patient days (PD) for top 26 agents. At 6 months, gap analysis determined the local staffing model covered only 52% of patients eligible for review. In 2015, ASN pharmacists were pooled in a single operational group independent of facility (12 FTEs). Centralized services were implemented with 3 remote ASN teams covering 13 facilities, 7 days per week (Figure 1). Services were expanded to include review of positive blood cultures, positive cultures with MDROs, bug-drug mismatches, and acute kidney injury on nephrotoxic antimicrobials. ASN teams used a combination of virtual and onsite daily review.
Results: Antimicrobial utilization decreased by 8.3% in 2014 compared to 2013 (564.2 DOT/1000 PD to 517.6 DOT/1000 PD). Implementation of the centralized model resulted in an additional 11.1 % decrease (517.6 DOT/1000 PD to 460.4 DOT/1000 PD), with an overall decrease by 18.4% compared to baseline (564.2 DOT/1000 PD to 460.4 DOT/1000 PD). The number of ASN interventions increased from 3,897 in 2014 to 11,612 in 2015, covering >95% of all eligible patients (Figure 2).
Conclusion: Implementation of a centralized ASP model in a large, healthcare system was more effective in reducing antimicrobial use than a traditional facility-based approach to antimicrobial stewardship.
L. E. Davidson,
S. Bear, None