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Effect of Communication Errors During Calls to an Antimicrobial Stewardship Program

Published online by Cambridge University Press:  02 January 2015

Darren R. Linkin ,
Neil O. Fishman ,
J. Richard Landis ,
Todd D. Barton ,
Steven Gluckman ,
Jay Kostman  and
Joshua P. Metlay
Darren R. Linkin*
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Veterans Affairs Medical Center, Philadelphia, Pennsylvania Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine, Philadelphia
Neil O. Fishman
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
J. Richard Landis
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Todd D. Barton
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Steven Gluckman
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Jay Kostman
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Joshua P. Metlay
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Veterans Affairs Medical Center, Philadelphia, Pennsylvania
*
809 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 (linkin@mail.med.upenn.edu)
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Abstract

Objective.

To determine how inaccurate communication of patient data by clinicians in telephone calls to the prior-approval antimicrobial stewardship program (ASP) staff affects the incidence of inappropriate antimicrobial recommendations made by ASP practitioners.

Design.

A retrospective cohort design was used. The accuracy of the patient data communicated was evaluated against patients' medical records to identify predetermined, clinically significant inaccuracies. Inappropriate antimicrobial recommendations were defined having been made if an expert panel unanimously rated the actual recommendations as inappropriate after reviewing vignettes derived from inpatients' medical records.

Setting.

The setting was an academic medical center with a prior-approval ASP.

Patients.

All inpatient subjects of ASP prior-approval calls were eligible for inclusion.

Results.

Of 200 ASP telephone calls, the panel agreed about whether or not antimicrobial recommendations were inappropriate for 163 calls (82%); these 163 calls were then used as the basis for further analyses. After controlling for confbunders, inaccurate communication was found to be associated with inappropriate antimicrobial recommendations (odds ratio [OR], of 2.2; P = .03). In secondary analyses of specific data types, only inaccuracies in microbiological data were associated with the study outcome (OR, 7.5; P = .002). The most common reason panelists gave for rating a recommendation as inappropriate was that antimicrobial therapy was not indicated.

Conclusions.

Inaccurate communication of patient data, particularly microbiological data, during prior-approval calls is associated with an increased risk of inappropriate antimicrobial recommendations from the ASP. Clinicians and ASP practitioners should work to confirm that critical data has been communicated accurately prior to use of that data in prescribing decisions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 12 , December 2007 , pp. 1374 - 1381
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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