Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T09:13:07.150Z Has data issue: false hasContentIssue false
  • English
  • Français

A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers

Published online by Cambridge University Press:  06 September 2018

Lauren D. Stevenson ,
Richard E. Banks ,
Krysttel C. Stryczek ,
Christopher J. Crnich ,
Emma M. Ide ,
Brigid M. Wilson ,
Roberto A. Viau ,
Sherry L. Ball  and
Robin L.P. Jump Open the ORCID record for Robin L.P. Jump [Opens in a new window]
Lauren D. Stevenson
Affiliation:
Interprofessional Implementation Research Evaluation and Clinical Center (IIRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Richard E. Banks
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Krysttel C. Stryczek
Affiliation:
Interprofessional Implementation Research Evaluation and Clinical Center (IIRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Christopher J. Crnich
Affiliation:
University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin
Emma M. Ide
Affiliation:
University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
Brigid M. Wilson
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Roberto A. Viau
Affiliation:
Medical Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Sherry L. Ball
Affiliation:
Interprofessional Implementation Research Evaluation and Clinical Center (IIRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Robin L.P. Jump*
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Medical Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio Specialty Care Center of Innovation, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
*
Author for correspondence: Robin L.P. Jump MD, PhD, GRECC 111O(W), Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, Cleveland, OH 44106. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access to infectious disease-trained specialists.

Design

A prospective quasi-experimental pilot study.

Setting

Two rural VAMCs with acute-care and long-term care units.

Intervention

At each intervention site, medical providers, pharmacists, infection preventionists, staff nurses, and off-site infectious disease physicians formed a videoconference antimicrobial stewardship team (VAST) that met weekly to discuss cases and antimicrobial stewardship-related education.

Methods

Descriptive measures included fidelity of implementation, number of cases discussed, infectious syndromes, types of recommendations, and acceptance rate of recommendations made by the VAST. Qualitative results stemmed from semi-structured interviews with VAST participants at the intervention sites.

Results

Each site adapted the VAST to suit their local needs. On average, sites A and B discussed 3.5 and 3.1 cases per session, respectively. At site A, 98 of 140 cases (70%) were from the acute-care units; at site B, 59 of 119 cases (50%) were from the acute-care units. The most common clinical syndrome discussed was pneumonia or respiratory syndrome (41% and 35% for sites A and B, respectively). Providers implemented most VAST recommendations, with an acceptance rate of 73% (186 of 256 recommendations) and 65% (99 of 153 recommendations) at sites A and B, respectively. Qualitative results based on 24 interviews revealed that participants valued the multidisciplinary aspects of the VAST sessions and felt that it improved their antimicrobial stewardship efforts and patient care.

Conclusions

This pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1163 - 1169
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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. Executive order—combating antibiotic-resistant bacteria. The White House website. https://obamawhitehouse.archives.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria. Accessed March 24, 2015.Google Scholar
2. Appropriate Antibiotic Use. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/index.html. Published January 17, 2018. Accessed April 1, 2018.Google Scholar
3. Medicare and Medicaid programs: reform of requirements for long-term care facilities. Federal Register website. https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities. Published October 4, 2016. Accessed November 8, 2016.Google Scholar
4. Prepublication standards—new antimicrobial stewardship standard. The Joint Commission website. https://www.jointcommission.org/prepublication_standards_antimicrobial_stewardship_standard/. Published 2016. Accessed September 10, 2016.Google Scholar
5. Stenehjem, E, Hyun, DY, Septimus, E, et al. Antibiotic stewardship in small hospitals: barriers and potential solutions. Clin Infect Dis 2017; 65:691–696.Google Scholar
6. Chou, AF, Graber, CJ, Jones, M, et al. Characteristics of antimicrobial stewardship programs at Veterans Affairs hospitals: results of a nationwide survey. Infect Control Amp Hosp Epidemiol 2016;37:647–654.Google Scholar
7. Siddiqui, J, Herchline, T, Kahlon, S, et al. Infectious Diseases Society of America position statement on telehealth and telemedicine as applied to the practice of infectious diseases. Clin Infect Dis 2017;64:237–242.Google Scholar
8. Implementation of antibiotic stewardship core elements at small and critical access hospitals. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements-small-critical.html. Published December 12, 2017. Accessed June 25, 2018.Google Scholar
9. Watts, SA, Roush, L, Julius, M, Sood, A. Improved glycemic control in veterans with poorly controlled diabetes mellitus using a specialty care access network-extension for community healthcare outcomes model at primary care clinics. J Telemed Telecare 2016;22:221–224.Google Scholar
10. Salgia, RJ, Mullan, PB, McCurdy, H, Sales, A, Moseley, RH, Su, GL. The educational impact of the specialty care access network—extension of community healthcare outcomes program. Telemed E-Health 2014; 20:1004–1008.Google Scholar
11. Glass, LM, Waljee, AK, McCurdy, H, Su, GL, Sales, A. Specialty care access network-extension of community healthcare outcomes model program for liver disease improves specialty care access. Dig Dis Sci 2017; 62:3344–3349.Google Scholar
12. Holden, RJ, Carayon, P, Gurses, AP, et al. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 2013;56:1669–1686.Google Scholar
13. Morquin, D, Ologeanu-Taddei, R, Koumar, Y, Bourret, R, Reynes, J. Implementing a tele-expertise system to optimise the antibiotic use and stewardship: the case of the Montpellier University Hospital (France). Stud Health Technol Inform 2015;210:296–300.Google Scholar
14. dos Santos, RP, Deutschendorf, C, Carvalho, OF, Timm, R, Sparenberg, A. Antimicrobial stewardship through telemedicine in a community hospital in southern Brazil. J Telemed Telecare 2013;19:1–4.Google Scholar
15. Yam, P, Fales, D, Jemison, J, Gillum, M, Bernstein, M. Implementation of an antimicrobial stewardship program in a rural hospital. Am J Health Syst Pharm 2012;69:1142–1148.Google Scholar
16. Ceradini, J, Tozzi, AE, D’Argenio, P, et al. Telemedicine as an effective intervention to improve antibiotic appropriateness prescription and to reduce costs in pediatrics. Ital J Pediatr 2017;43:105.Google Scholar
17. Veillette, JJ, Vento, T, Gelman, S, et al. Implementation of a centralized telehealth-based antimicrobial stewardship program (ASP) for 16 small community hospitals (SCHs). Open Forum Infect Dis 2017; 4 Suppl 1:S278–S279.Google Scholar
18. Zhou, Y, Lynch, JB, Pottinger, PS, et al. University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP/ECHO): collaboration across Washington state to improve antimicrobial use. Open Forum Infect Dis 2017;4 Suppl 1:S271–S271.Google Scholar
19. Olans, RN, Olans, RD, DeMaria, A. The critical role of the staff nurse in antimicrobial stewardship—unrecognized, but already there. Clin Infect Dis 2016;62:84–89.Google Scholar
20. Stevenson, L, Ball, S, Haverhals, LM, Aron, DC, Lowery, J. Evaluation of a national telemedicine initiative in the Veterans Health Administration: factors associated with successful implementation. J Telemed Telecare 2018;24:168–178.Google Scholar
21. Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Executive summary: implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis Off Publ Infect Dis Soc Am 2016;62:1197–1202.Google Scholar
22. Champions—CFIR Wiki. Consolidated Framework for Implementation Research website. http://cfirguide.org/wiki/index.php?title=Champions. Updated 2018. Accessed July 6, 2018.Google Scholar
Supplementary material: File

Stevenson et al. supplementary material

Stevenson et al. supplementary material 1

Download Stevenson et al. supplementary material(File)
File 24.4 KB