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nursing attended several sessions, demonstrating leadership engagement. Site A also engaged in reflection and evaluation of the VAST with tangible changes such as adjusting the day and location to better suit attendees’ needs. Additionally, the infection preven- tionist at site A regularly included a “kudos” case for which the VAST recognized and celebrated a provider’s good antimicrobial stewardship practices. Finally, the VAST filled a gap at site A, which did not have access to a local infectious disease expert, compared to site B, where an infectious diseases physician had recently started making rounds weekly. Champions are important facilitators when implementing
successful programs, including those related to antimicrobial stewardship.21 They promote and support intervention and can also overcome indifference or resistance.22 The champions at both intervention sites were instrumental to the VASTs’ success. In addition to aligning VAST-related activities with their work responsibilities, they also served as primary points of contact for the off-site infectious disease physicians as well as for individuals at their sites. This study has several limitations. First, both intervention sites
had pre-existing relationships with the off-site infectious disease physicians; this likely facilitated successful implementation. Future renditions of the VAST will need to cultivate trust and relationships among team members. Second, not all VAST par- ticipants engaged in interviews, which may have influenced the tone of the qualitative results. Third, an unintended consequence of the VAST reported from site A was that providers would sometimes wait for a weekly VAST session to inform some aspects of patient care, leading to potential delays in treatment decisions. As the providers grew more comfortable with the VAST, phone calls to infectious disease physicians and e-consults may have mitigated some of these delays. Our pilot project has demonstrated that telehealth is a viable
method to expand access to specialty care and promote anti- microbial stewardship within the VA. In addition to evaluating the influence of the VAST on antibiotic use at the intervention sites, future activities will expand implementation to other VAMCs with limited access to infectious disease expertise.
Supplementary materials. To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2018.197
Acknowledgments. The authors are grateful to the VAST participants at both intervention sites, and particularly thank Yvonne Jones, Jason Cherry, Brett Anderson, Stacey Hirth, and David C. Aron. The findings and conclu- sions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the VA or of the United States Government.
Financial support. This work was supported by the Veterans Affairs Merit Review Program (grant no. PPO 16-118-1 to R.J.) and, in part, by funds and facilities provided by the Cleveland Geriatric Research Education and Clinical Center (GRECC) and the Specialty Care Center of Innovation at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center.
Conflicts of interest. R.J. is the principal investigator on research grants from Steris and Pfizer; she has also participated in advisory boards for Pfizer and Merck. None of the other authors have relevant conflicts of interest to disclose.
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