Sustainability of Handshake Stewardship: Extending a Hand Is Effective Years Later

Area of Science:

• Infectious Diseases
• Hospital Administration
• Pharmacology

Background:

• Children's Hospital Colorado implemented a novel "handshake stewardship" program in 2013 to optimize antimicrobial use.
• This unique approach involves physician-pharmacist collaboration, daily rounding, and direct provider support without prior authorization.
• The program aimed to decrease hospital anti-infective use and associated costs.

Purpose of the Study:

• To reevaluate the long-term outcomes of the handshake stewardship program after five years of implementation.
• To analyze eight years of data (2010-2018) to assess the program's sustained impact on antimicrobial prescribing.
• To determine the program's effect on overall anti-infective use, patient outcomes, and healthcare costs.

Main Methods:

• Retrospective analysis of hospital-wide anti-infective (antibiotic, antiviral, antifungal) use from October 2010 to October 2018.
• Measurement of aggregated monthly use in days of therapy per thousand patient days (DOT/1000 PD).
• Assessment of the percentage of children receiving any anti-infective, severity-adjusted mortality, readmissions, and length of stay.

Main Results:

• Hospital-wide anti-infective use decreased significantly from 891 to 655 DOT/1000 PD (a reduction of 26.5%).
• Antibacterial use saw a substantial decline from 704 to 544 DOT/1000 PD.
• The proportion of admitted children receiving any anti-infective dropped from 65% to 52%, with no adverse effects on mortality, readmissions, or length of stay.

Conclusions:

• The handshake stewardship method is a highly effective and sustainable strategy for reducing hospital anti-infective consumption.
• This collaborative, provider-centric approach demonstrates significant long-term success in antimicrobial stewardship.
• The program achieved its goals without compromising patient safety or clinical outcomes.