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A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers

Published online by Cambridge University Press:  06 September 2018

Lauren D. Stevenson
Affiliation:
Interprofessional Implementation Research Evaluation and Clinical Center (IIRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Richard E. Banks
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Krysttel C. Stryczek
Affiliation:
Interprofessional Implementation Research Evaluation and Clinical Center (IIRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Christopher J. Crnich
Affiliation:
University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin
Emma M. Ide
Affiliation:
University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
Brigid M. Wilson
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Roberto A. Viau
Affiliation:
Medical Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Sherry L. Ball
Affiliation:
Interprofessional Implementation Research Evaluation and Clinical Center (IIRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Robin L.P. Jump*
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Medical Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio Specialty Care Center of Innovation, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
*
Author for correspondence: Robin L.P. Jump MD, PhD, GRECC 111O(W), Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, Cleveland, OH 44106. E-mail: robin.jump@va.gov

Abstract

Objective

To test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access to infectious disease-trained specialists.

Design

A prospective quasi-experimental pilot study.

Setting

Two rural VAMCs with acute-care and long-term care units.

Intervention

At each intervention site, medical providers, pharmacists, infection preventionists, staff nurses, and off-site infectious disease physicians formed a videoconference antimicrobial stewardship team (VAST) that met weekly to discuss cases and antimicrobial stewardship-related education.

Methods

Descriptive measures included fidelity of implementation, number of cases discussed, infectious syndromes, types of recommendations, and acceptance rate of recommendations made by the VAST. Qualitative results stemmed from semi-structured interviews with VAST participants at the intervention sites.

Results

Each site adapted the VAST to suit their local needs. On average, sites A and B discussed 3.5 and 3.1 cases per session, respectively. At site A, 98 of 140 cases (70%) were from the acute-care units; at site B, 59 of 119 cases (50%) were from the acute-care units. The most common clinical syndrome discussed was pneumonia or respiratory syndrome (41% and 35% for sites A and B, respectively). Providers implemented most VAST recommendations, with an acceptance rate of 73% (186 of 256 recommendations) and 65% (99 of 153 recommendations) at sites A and B, respectively. Qualitative results based on 24 interviews revealed that participants valued the multidisciplinary aspects of the VAST sessions and felt that it improved their antimicrobial stewardship efforts and patient care.

Conclusions

This pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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