Poster: Increased Efficiency and Impact of Implementing ILÚM Insight in an Antimicrobial Stewardship Program (ASP) at an Academic Medical Center

This poster highlighting ILÚM Insight was originally presented at IDWeek 2022, held Oct. 19-23 in Washington, D.C.

Ryan K. Shields¹, Rachel V. Marini¹, Sunish Shah¹, Bonnie Falcione¹, Brian Potoski¹, Leanna Liu¹, Eli Goshorn¹, Lloyd Clarke¹, Alex Viehman¹, Chrstiane Hadi¹, EJ Kwak¹, Palash Samanta¹, Tina Khadem^1,2, J. Ryan Bariola^1,2, Caley Yakemowicz², Courtney Simonick², Riaan Erwee², Erin K. McCreary^1,2, Rima Abdel-Massih², M. Hong Nguyen¹

1. Antibiotic Management Program, UPMC Presbyterian Hospital, Pittsburgh, PA 2. Infectious Disease Connect, Inc., Pittsburgh, PA

Conclusions

ILÚM Insight improves the efficiency of the daily ASP workflow
Implementation of the software significantly decreased antimicrobial utilization without increasing the number of ASP team members

Background

Antimicrobial stewardship programs (ASP) are mandatory for all hospitals
AS Programs require extensive resources with multidisciplinary collaboration
The study examined the potential efficiency and effectiveness of ASP improvements during the implementation of real-time clinical decision support software (CDSS) at UPMC Presbyterian Hospital, in Pittsburgh, PA
Prior to this implementation, the facility relied on both prior authorizations (since 2002) and focused audits with feedback (since 2015) as ASP mechanisms
The new CDSS selected was ILÚM Insight because the platform provided real-time notifications, organized communications, and patient- and provider-level data tracking
The study evaluated the hypothesis that ILÚM Insight would increase efficiency of ASP workflows and decrease antimicrobial utilization

Methods

The hypothesis was tested by analyzing data from a comparable 6-month time frame: 8/2020-1/2021 vs. 8/2021-1/2022 — during which time no significant staffing changes occurred
During implementation, notifications within ILÚM Insight were tailored to local practices, incorporating alerts targeting intervention directives for positive blood cultures, antibiotic de-escalation and bug0drug mismatches
During CDSS implementation new notifications were added for restricted antimicrobials, antibiotic timeouts, and MRSA screenings
ASP pharmacists received CDSS training in July
ASP physicians received CDSS training in November

Results

More than 5,500 notifications across nine different ASP intervention types were recorded once Insight was implemented (Figure 1)
The number of interventions made by the ASP increased while missed opportunities decreased (Figure 2)
ASP communications rose from 205 to 1,200 per month (Figure 2)
Antimicrobial days of therapy (DOT) per 1,000 patient days (PD) decreased by 14.5% from a median of 969 to 846 per month (Fig 3; P=0.002)
Antimicrobial expenditures decreased by a median 21% per month during the post-intervention period compared to baseline
30-day re-admissions decreased from 330 to 262 incidents among patients prescribed antimicrobials during an indexed admission (Figure 4)
Re-admissions associated with re-ordering of antimicrobials decreased from 235 to 182 encounters among patients prescribed antimicrobials during an indexed admission (Figure 4)