Problem:
A rural community health system with three hospitals that serve residents in three states sought Infectious Disease Connect’s virtual stewardship services to provide expertise in structuring and maintaining their antimicrobial stewardship program (ASP).
Before ID Connect teamed up with this health system, they were particularly concerned about their antibiotic use, laboratory utilization costs related to infectious disease workups, and increasing hospital onset C. difficile infection rates.
Solution:
To develop a customized solution, a dedicated Infectious Diseases (ID) physician and ID pharmacist conducted a complete audit of the health system’s current stewardship efforts. Together with the hospital staff, the team identified several deficiencies that required immediate attention:
- Incomplete NHSN AUR Module Reporting – a new CMS requirement for calendar year 2024
- Invalid antibiotic use data in the system’s existing clinical surveillance software
- Excessive length of stay (LOS) in diabetic foot and vascular wound management cases
- Inconsistent guideline adherence within different provider groups
- Excessive ordering of low-impact diagnostic laboratory tests
- Non-standard of care diagnostic algorithms for treating C. difficile
- Excessive urine culture ordering and treatment of asymptomatic bacteriuria
- Excessive empiric vancomycin use and high toxicity rates
- Unrealized cost-optimization opportunities from implementing antibiotic treatment pathways
By crafting a 30 hour a month tele-ASP, the ID Connect physician and pharmacist worked with the system’s professionals to develop a detailed roadmap to address these and other issues. Some of ID Connect’s direct ASP support activities included:
- Providing tailored didactic education to multiple stakeholder groups including hospitalists, emergency medicine physicians, surgeons, and pharmacists based on group need and antimicrobial stewardship gap opportunities
- Chairing the health system’s ASP committee to continuously identify ASP deficits, recommend solutions, and implement changes involving coordination with infection prevention, microbiology, pharmacy, hospital and system leadership
- Educating local non-infectious diseases pharmacists on how to conduct prospective audits, establishing patient review priority lists, and providing guidance on how to effectively intervene on patient cases
- Collaborating with the microbiology laboratory leadership to implement best practices for susceptibility testing and updated breakpoints
- Performing medication utilization evaluations on target antimicrobials and laboratory utilization evaluations for frequently ordered diagnostic tests
- Identifying opportunities for impactful quality improvement initiatives and collaborating with stakeholder groups to execute on those identified opportunities
- Tracking, evaluating, and reporting ASP metrics and guideline adherence
- Providing expert guidance on implementation of the newly required National Hospital Safety Network’s antimicrobial use and resistance (AUR) reporting module
Additionally, ID Connect’s physician and pharmacist provided systemwide microbiology and infection prevention support. Along with our client partners, we also created and revised infectious disease clinical pathways, guidelines, and policies including the system’s first COVID-19 therapy guidelines.
Results:
Through these combined efforts, ID Connect estimates that the system achieved a total annualized cost savings of $1.25 Million. Highlights of our cost reduction and quality improvements included:
An 11% reduction
in total antimicrobial use sustained over a 16-month period post-implementation of the ID Connect-led ASP
A 41% reduction
in hospital-onset C. difficile infections and a 31% reduction in consumption of C. difficile therapeutics
A 30.2% reduction
in vancomycin duration of therapy leading to a 13.3% relative reduction in vancomycin-associated acute kidney injuries
An annualized cost-savings of $28,500 a year
due to removal of Streptococcus pneumoniae urinary antigen testing
Tele-ASP is a Cost-Effective Long-Term Solution
Virtual ASP are not one-size-fits-all. Therefore, our ID physicians and pharmacists use their real-world experience to build solutions best suited to each hospital or health system’s needs. To customize our services, we review current institutional ASP structures and current infectious diseases, microbiology, and infection prevention and control best practices to construct a program that suits your current needs and fulfills accreditation requirements and compliance regulations. ID Connect’s tele-ID and ASP experts are specialized resources that your onsite physicians and pharmacists can consult with to help them provide better patient care and clinical outcomes.
Our other virtual ASP services clients tell us that the ID Connect team is essential in helping their hospitals reduce unnecessary antibiotic use, prevent the emergence of antimicrobial-resistant infections, and optimize patient outcomes while reducing those costs associated with longer hospital stays, readmissions, and tertiary transfers.
Ready to get started? Contact us at sales@idctelemed.com to learn more.
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