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21 results

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  • The use of telehealth-supported stewardship activities in acute-care and long-term care settings: An implementation effectiveness trial

  • Daniel J. Livorsi, Stacey Hockett Sherlock, Cassie Cunningham Goedken, Sandra Pratt, David A. Goodman, Kim C. Clarke, Hyunkeun Cho, Heather Schacht Reisinger, Eli N. Perencevich
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 44 / Issue 12 / December 2023
    Published online by Cambridge University Press:
    14 June 2023, pp. 2028-2035
    Print publication:
    December 2023
    • Article
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  • Background:

    We assessed the implementation of telehealth-supported stewardship activities in acute-care units and long-term care (LTC) units in Veterans’ Administration medical centers (VAMCs).

    Design:

    Before-and-after, quasi-experimental implementation effectiveness study with a baseline period (2019–2020) and an intervention period (2021).

    Setting:

    The study was conducted in 3 VAMCs without onsite infectious disease (ID) support.

    Participants:

    The study included inpatient providers at participating sites who prescribe antibiotics.

    Intervention:

    During 2021, an ID physician met virtually 3 times per week with the stewardship pharmacist at each participating VAMC to review patients on antibiotics in acute-care units and LTC units. Real-time feedback on prescribing antibiotics was given to providers. Additional implementation strategies included stakeholder engagement, education, and quality monitoring.

    Methods:

    The reach–effectiveness–adoption–implementation–maintenance (RE-AIM) framework was used for program evaluation. The primary outcome of effectiveness was antibiotic days of therapy (DOT) per 1,000 days present aggregated across all 3 sites. An interrupted time-series analysis was performed to compare this rate during the intervention and baseline periods. Electronic surveys, periodic reflections, and semistructured interviews were used to assess other RE-AIM outcomes.

    Results:

    The telehealth program reviewed 502 unique patients and made 681 recommendations to 24 providers; 77% of recommendations were accepted. After program initiation, antibiotic DOT immediately decreased in the LTC units (−30%; P < .01) without a significant immediate change in the acute-care units (+16%; P = .22); thereafter DOT remained stable in both settings. Providers generally appreciated feedback and collaborative discussions.

    Conclusions:

    The implementation of our telehealth program was associated with reductions in antibiotic use in the LTC units but not in the smaller acute-care units. Overall, providers perceived the intervention as acceptable. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use.

Clinical Manual of Emergency Pediatrics
  • 5th edition
  • Edited by Ellen F. Crain, Jeffrey C. Gershel
  • Edited in association with Sandra J. Cunningham
  • Published online:
    10 January 2011
    Print publication:
    02 December 2010
  • Clinical Manual of Emergency Pediatrics, 5th edition, is a concise, portable handbook summarizing the wide range of conditions encountered in pediatric emergency departments. As children with acute problems often receive care in private offices and clinics, it is equally relevant for pediatricians, emergency medicine physicians, family practitioners and internists.The 5th edition of this hugely successful resource is the leading book of its kind for several reasons:Clear, concise guidance is given for patient evaluation and follow-up and explicit indications for admissionEvery chapter is organized in a standard format, making it very easy for a reader to locate critical information rapidlyA dedicated 'Special Considerations' chapter addresses difficult problems such as the crying infant and the cross-cultural encounterNumerous new topics are included, making Clinical Manual of Emergency Pediatrics, 5th edition an invaluable resource for any physician working in acute care settings where children are seen.

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