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Influence of an infectious diseases specialist on ICU multidisciplinary rounds
1Department of Medical Education, Providence Portland Medical Center, 5050 NE Hoyt, Suite 540, Portland, OR 97213, USA.
Abstract:
Objective. To ascertain the influence of a physician infectious diseases specialist (IDS) on antibiotic use in a medical/surgical intensive care unit. Method. Over a 5-month period, the antibiotic regimens ordered by the ICU multidisciplinary team were studied. The days of antibiotic therapy (DOT) when management decisions included an IDS were compared to DOT in the absence of an IDS. The associated treatment expense was calculated. Results. Prior to multidisciplinary rounds (MDRs), 79-80% of the patients were receiving one or more antibiotic. IDS participation occurred in 61 multidisciplinary rounding sessions. There were 384 patients who before MDRs had orders for 669 days of antimicrobial therapy (DOT). After MDRs, the antimicrobial DOT were reduced to 511 with a concomitant cost saving of $3772. There were 51 MDR sessions that occurred in the absence of the IDS. There were 352 patients who before MDRs had orders for 593 DOT. After MDRs, the DOT were reduced to 572 with a cost savings of $727. The results were normalized by number of patients evaluated with statistically greater reductions when MDRs included the IDS. In addition, the number of rounding sessions with a reduction in DOT was greater with the participation of the IDS. Conclusion. The addition of an IDS to multidisciplinary ICU patient rounds resulted in a reduction in antibiotic DOT and attendant drug expense.
Insights
Adding an infectious diseases specialist (IDS) to multidisciplinary rounds in intensive care units (ICUs) significantly reduced antibiotic use and associated costs. This specialist involvement optimized antimicrobial therapy duration and expense.
Area of Science:
- Infectious Diseases
- Intensive Care Medicine
- Health Economics
Background:
- Antibiotic overuse is a significant concern in intensive care units (ICUs).
- Multidisciplinary rounds are common in ICUs but may lack specialized infectious diseases expertise.
Purpose of the Study:
- To evaluate the impact of an infectious diseases specialist (IDS) on antibiotic prescribing patterns.
- To assess the effect of IDS involvement on antibiotic days of therapy (DOT) and treatment costs in a medical/surgical ICU.
Main Methods:
- A 5-month observational study comparing antibiotic use during multidisciplinary rounds (MDRs) with and without IDS participation.
- Analysis of antibiotic regimens, days of antibiotic therapy (DOT), and calculated treatment expenses.
- Data normalized by the number of patients evaluated.
Main Results:
- IDS participation in 61 MDR sessions led to a reduction of 158 DOT and $3772 in costs.
- MDRs without IDS participation in 51 sessions resulted in a reduction of 21 DOT and $727 in costs.
- Statistically greater reductions in DOT and a higher number of DOT-reducing sessions were observed when an IDS was involved.
Conclusions:
- Integrating an infectious diseases specialist into multidisciplinary ICU rounds effectively reduces antibiotic consumption.
- IDS involvement leads to significant cost savings related to antimicrobial drug expenses.
- Specialized infectious diseases input optimizes antibiotic stewardship in the ICU setting.
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