Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-12-01T00:08:38.940Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of Communication Errors During Calls to an Antimicrobial Stewardship Program

Published online by Cambridge University Press:  02 January 2015

Darren R. Linkin ,
Neil O. Fishman ,
J. Richard Landis ,
Todd D. Barton ,
Steven Gluckman ,
Jay Kostman  and
Joshua P. Metlay
Darren R. Linkin*
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Veterans Affairs Medical Center, Philadelphia, Pennsylvania Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine, Philadelphia
Neil O. Fishman
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
J. Richard Landis
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Todd D. Barton
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Steven Gluckman
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Jay Kostman
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Joshua P. Metlay
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Veterans Affairs Medical Center, Philadelphia, Pennsylvania
*
809 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine how inaccurate communication of patient data by clinicians in telephone calls to the prior-approval antimicrobial stewardship program (ASP) staff affects the incidence of inappropriate antimicrobial recommendations made by ASP practitioners.

Design.

A retrospective cohort design was used. The accuracy of the patient data communicated was evaluated against patients' medical records to identify predetermined, clinically significant inaccuracies. Inappropriate antimicrobial recommendations were defined having been made if an expert panel unanimously rated the actual recommendations as inappropriate after reviewing vignettes derived from inpatients' medical records.

Setting.

The setting was an academic medical center with a prior-approval ASP.

Patients.

All inpatient subjects of ASP prior-approval calls were eligible for inclusion.

Results.

Of 200 ASP telephone calls, the panel agreed about whether or not antimicrobial recommendations were inappropriate for 163 calls (82%); these 163 calls were then used as the basis for further analyses. After controlling for confbunders, inaccurate communication was found to be associated with inappropriate antimicrobial recommendations (odds ratio [OR], of 2.2; P = .03). In secondary analyses of specific data types, only inaccuracies in microbiological data were associated with the study outcome (OR, 7.5; P = .002). The most common reason panelists gave for rating a recommendation as inappropriate was that antimicrobial therapy was not indicated.

Conclusions.

Inaccurate communication of patient data, particularly microbiological data, during prior-approval calls is associated with an increased risk of inappropriate antimicrobial recommendations from the ASP. Clinicians and ASP practitioners should work to confirm that critical data has been communicated accurately prior to use of that data in prescribing decisions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 12 , December 2007 , pp. 1374 - 1381
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and healthcare costs. Clin Infect Dis 2006;42(suppl 2):S82–S89.Google Scholar
2.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.CrossRefGoogle ScholarPubMed
3.Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972–978.CrossRefGoogle ScholarPubMed
4.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
5.John, JF Jr, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471–485.Google Scholar
6.White, AC Jr, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230–239.Google Scholar
7.Frank, MO, Batteiger, BE, Sorensen, SJ, et al. Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clin Perform Qual Health Care 1997;5:180–188.Google Scholar
8.Gross, R, Morgan, AS, Kinky, DE, Weiner, M, Gibson, GA, Fishman, NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001;33:289–295.Google Scholar
9.Shlaes, DM, Gerding, DN, John, JF Jr, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275–291.CrossRefGoogle Scholar
10.Lawton, RM, Fridkin, SK, Gaynes, RP, McGowan, JE Jr. Practices to improve antimicrobial use at 47 US hospitals: the status of the 1997 SHEA/IDSA position paper recommendations. Society for Healthcare Epidemiology of America/Infectious Diseases Society of America. Infect Control Hosp Epidemiol 2000;21:256–259.CrossRefGoogle ScholarPubMed
11.Linkin, DR, Paris, S, Fishman, NO, Metlay, JP, Lautenbach, E. Inaccurate communications in telephone calls to an antimicrobial stewardship program. Infect Control Hosp Epidemiol 2006;27:688–694.CrossRefGoogle Scholar
12.University of Pennsylvania Medical Center. University of Pennsylvania Medical Center guidelines for antibiotic use: commonly used anti-infectives and restriction categories. Available at: http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/restrict.htm. Accessed October 14, 2007.Google Scholar
13.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.Google Scholar
14.Kieszak, SM, Flanders, WD, Kosinski, AS, Shipp, CC, Karp, H. A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data. J Clin Epidemiol 1999;52:137–142.Google Scholar
15.Stelfox, HT, Bates, DW, Redelmeir, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
16. Standards, practice guidelines, and statements developed and/or endorsed by the Infectious Diseases Society of America. Available at: http://www.idsociety.org/Content.aspx?id=4204. Accessed May 26, 2006.Google Scholar
17.Rand Corporation. Available at: http://www.rand.org/. Accessed May 15, 2007.Google Scholar
18.Park, RE, Fink, A, Brook, RH, et al. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health 1986;76:766–772.Google Scholar
19.Leape, LL, Hilborne, LH, Park, RE, et al. The appropriateness of use of coronary artery bypass graft surgery in New York State. JAMA 1993;269:753–760.Google Scholar
20.Localio, AR, Berlin, JA, Ten Have, TR, Kimmel, SE. Adjustments for center in multicenter studies: an overview. Ann Intern Med 2001;135:112–123.Google Scholar
21.Calfee, DP, Brooks, J, Zirk, NM, Giannetta, ET, Scheid, WM, Farr, BM. A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme. J Hosp Infect 2003;55 26–32Google Scholar
22.Green, MJ, Farber, NJ, Ubel, PA, et al. Lying to each other: when internal medicine residents use deception with their colleagues. Arch Intern Med 2000;160:2317–2323.Google Scholar
23.Jagsi, R, Kitch, BT, Weinstein, DF, Campbell, EG, Hutter, M, Weissman, JS. Residents report on adverse events and their causes. Arch Intern Med 2005;165:2607–2613.Google Scholar
24.Evans, RS, Pestotnik, SL, Classen, DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998;338:232–238.Google Scholar