Infection Control & Hospital Epidemiology (2018), 39, 1163–1169 doi:10.1017/ice.2018.197
Original Article
A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers
Lauren D. Stevenson PhD1, Richard E. Banks AS2, Krysttel C. Stryczek MA1, Christopher J. Crnich MD, PhD3,4, Emma M. Ide BS3, Brigid M. Wilson PhD2, Roberto A. Viau MD5,6, Sherry L. Ball PhD1 and
Robin L.P. Jump MD, PhD2,5,6,7,8 1Interprofessional Implementation Research Evaluation and Clinical Center (IIRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, 2Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland,
Ohio, 3University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, 4William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin, 5Medical Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, 6Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, 7Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio and 8Specialty Care Center of Innovation, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
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.
(Received 15 May 2018; accepted 21 July 2018; electronically published September 6, 2018)
The threats posed by antimicrobial resistance have led to strong recommendations and regulatory actions. The number of trained infectious disease physicians and pharmacists is insufficient to meet the urgent need for comprehensive
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 PREVIOUS PRESENTATION. Presented in part at the 2017 Geriatric Extended Care
(GEC) Leads Conference in Orlando, Florida, on April 6-7, 2017; at ID Week in San Diego, California, on October 4-8, 2017; and at the 10th Annual Conference on the Science of Dissemination and Implementation in Arlington, Virginia, on December 4- 6, 2017
Cite this article: Stevenson L, et al. (2018). A pilot study using telehealth to
implement antimicrobial stewardship at two rural Veterans Affairs medical centers. Infection Control & Hospital Epidemiology 2018, 39, 1163–1169. doi: 10.1017/ice.2018.197
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
ship programs in small and rural hospitals is telehealth.5,7,8 The VA has successfully used telemedicine to increase veterans’ access to specialty care providers. Titled the Specialty Care Access Network Extension for Community Healthcare Outcomes
antimicrobial stewardship programs across healthcare set- tings,1–5 including the Veterans Health Administration, the largest integrated healthcare system in the United States. A 2012 survey found that of 130 Veterans Affairs medical centers (VAMCs) providing inpatient care, 52 (40%) did not have a full-time infectious disease physician on staff.6 Thus, the implementation of antimicrobial stewardship programs often depends on professionals, including physicians, pharmacists, and nurses, who lack training in infectious diseases or anti- microbial stewardship. One proposed solution for supporting antimicrobial steward-
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