Telehealth-based antimicrobial stewardship program worked in 2 community hospitals

The program, which included remote consults with infectious disease physicians, led to reductions in broad-spectrum antibiotic use and antimicrobial expenditures.

Through a partnership between two health systems, two community hospitals went from having no formal antimicrobial stewardship program to seeing positive results from a telehealth-based stewardship program.

The hospitals implemented a stewardship program in which local pharmacists were trained to conduct prospective audit and feedback. As part of the intervention, infectious disease physicians from a separate health system remotely reviewed patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft-tissue infections with the local pharmacists for about 60 minutes three times weekly at the 285-bed hospital and two times weekly at the 176-bed hospital. The pharmacists tracked the physicians' recommendations for antimicrobial stewardship program interventions and relayed them to primary teams.

Researchers measured antimicrobial utilization in days of therapy per 1,000 patient-days for a 12-month baseline period and a six-month intervention period and also estimated antimicrobial cost savings. Results were published online on Sept. 5 by Clinical Infectious Diseases.

During the six-month intervention period, 1,419 infectious disease physician recommendations were made, and 1,262 (88.9%) were accepted. Compared to baseline, broad-spectrum antibiotic use decreased by 24.4% (342.1 vs. 258.7 days of therapy per 1,000 patient-days; P<0.001) during the intervention period. Infectious disease consults increased by 40.2% (15.4 consults per 1,000 patient-days vs. 21.5 consults per 1,000 patient-days; P=0.001). Estimated savings on antimicrobial expenditures were $142,629.83 per year.

Limitations of the study were its nonrandomized design and its focus on overall antimicrobial utilization, rather than on appropriateness of therapy or patient outcomes, the authors noted. Nonetheless, the intervention “represents a unique and viable strategy by which community hospitals not affiliated with a large system may gain access to robust stewardship support, and a mechanism by which larger institutions with such infrastructure may assist unaffiliated hospitals with expansion of [antimicrobial stewardship program] efforts,” they concluded.

For more telehealth news, read the cover story of the August ACP Hospitalist, which showed how health systems are using remote services in hospital medicine, infectious diseases, and the ICU.