Remote Antimicrobial Stewardship in Community Hospitals

Area of Science:

• Infectious Diseases
• Health Services Research
• Pharmacy Practice

Background:

• Antimicrobial stewardship is standard in academic centers but challenging in community hospitals lacking infectious disease specialists.
• Vidant Health implemented a remote antimicrobial stewardship program in six community hospitals starting in 2011.
• The program utilized pharmacists at a central medical center to remotely review patient charts.

Purpose of the Study:

• To assess the feasibility and physician acceptance of a remote antimicrobial stewardship program in community hospitals.
• To evaluate the impact of the program on antimicrobial prescribing patterns.
• To explore the potential for expanding stewardship initiatives in underserved areas.

Main Methods:

• Pharmacists remotely reviewed charts via electronic medical records (EMR).
• Recommendations included streamlining, discontinuing, or switching antimicrobial agents.
• Data on chart reviews, recommendations, acceptance rates, and antimicrobial use were collected.
• Linear regression analyzed changes in antimicrobial use over time.

Main Results:

• Recommendations were made in an average of 45 charts per month per hospital for larger facilities.
• Physician acceptance of recommendations ranged from 83% to 88%.
• No significant decrease in overall antimicrobial use was observed, partly due to use outside the program's review.
• Quinolone use decreased by over 50% in two of the four larger hospitals.

Conclusions:

• Remote antimicrobial stewardship using EMRs is a feasible model for community hospitals.
• The program was generally well-received by physicians.
• This model offers an opportunity to extend antimicrobial stewardship beyond academic medical centers, especially as EMR adoption increases.