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Staffing and workflow of an interactive telehealth Antimicrobial Stewardship program with the Veterans Health
Amanda Vivo1, Geneva M Wilson1,2, Dustin D French1,3
1https://ror.org/05rsv9s98VA Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, USA.
Objective:
Describe the workload associated with using telehealth to support Antimicrobial Stewardship efforts at Veterans Affairs Medical Centers (VAMCs) without local infectious diseases (ID) expertise.
Design:
A mixed-methods process assessment to evaluate workload and workflow associated with Videoconference Antimicrobial Stewardship Teams (VASTs).
Setting And Participants:
Rural VAMC champions paired with ID consultants at geographically distant VAMCs to form VASTs.
Methods:
Total workload estimates were based on time that champions and ID consultants allocated to VAST activities. Clinical Procedural Terminology (CPT) codes were used to estimate the workloads for clinical encounters. Role-based process maps were developed to understand variation in implementation by VAMC.
Results:
The average workload that champions and ID consultants allocated to VAST activities was 6.7% (range 1.0%-20.0%) and 8.4% (range 2.0%-12.5%) full-time equivalents (FTEs), respectively. Clinical encounters completed by ID consultants contributed an average of 1.4% (range < 0.01%-2.5%) FTEs to the workload. The average proportion of FTEs required to sustain VASTs was 13.0% (range 3.0%-31.6%). Process maps showed four phases common to each VAST's workflow: case identification, meeting preparation, team meeting, and documentation. The tasks associated with each phase varied between VASTs. Champions carried out most tasks related to case finding and meeting preparation; the ID consultants completed most documentation tasks.
Conclusions:
The distribution of tasks within and among the VASTs indicated opportunities to improve workflow efficiency. Investing <12.5% of the FTE allocated to VA Antimicrobial Stewardship programs to support the time of an ID consultant from another VAMC can help rural VAMCs achieve staffing sustainability.
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