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Recommendations made and accepted by a telehealth-enabled Antimicrobial Stewardship program implemented at rural veterans affairs medical centers

Published online by Cambridge University Press:  04 May 2026

Taissa A. Bej Open the ORCID record for Taissa A. Bej [Opens in a new window] ,
Amelia L. Milner ,
Alexandria Nguyen ,
Amanda Vivo Open the ORCID record for Amanda Vivo [Opens in a new window] ,
Geneva Wilson Open the ORCID record for Geneva Wilson [Opens in a new window] ,
Sara Abdelrahim Open the ORCID record for Sara Abdelrahim [Opens in a new window] ,
Brigid M. Wilson Open the ORCID record for Brigid M. Wilson [Opens in a new window] ,
Corinne Kowal Open the ORCID record for Corinne Kowal [Opens in a new window] ,
Sunah Song Open the ORCID record for Sunah Song [Opens in a new window]  and
Keri L. Rodriguez Open the ORCID record for Keri L. Rodriguez [Opens in a new window]
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Taissa A. Bej
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA
Amelia L. Milner
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA
Alexandria Nguyen
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA
Amanda Vivo
Affiliation:
VA Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
Geneva Wilson
Affiliation:
VA Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Sara Abdelrahim
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA
Brigid M. Wilson
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
Corinne Kowal
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA
Sunah Song
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
Keri L. Rodriguez
Affiliation:
The Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
Nicole Beyer
Affiliation:
The Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
Zachary Michaels
Affiliation:
The Center for Healthcare Evaluation, Research, and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
Carla Amundson
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
Kristina L. Bajema
Affiliation:
VA Portland Health Care System, Portland, OR, USA Department of Medicine, Oregon Health & Science University, Portland, OR, USA
Jason P. Burnham
Affiliation:
St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA Washington University in St. Louis School of Medicine, St. Louis, MO, USA
Christopher J. Crnich
Affiliation:
William S. Middleton Memorial VA Hospital, Madison, WI, USA University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Dimitri M. Drekonja
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA University of Minnesota, Minneapolis, MN, USA
Lauren Epstein
Affiliation:
Atlanta VA Medical Center, Decatur, GA, USA Emory University School of Medicine, Atlanta, GA, USA
Tola Ewers
Affiliation:
William S. Middleton Memorial VA Hospital, Madison, WI, USA University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Daniel J. Livorsi
Affiliation:
Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA University of Iowa Carver College of Medicine, Iowa City, IA, USA
Muthu Narayan
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA University of Minnesota, Minneapolis, MN, USA
Joshua D. Nordman
Affiliation:
St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA Washington University in St. Louis School of Medicine, St. Louis, MO, USA
Federico Perez
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
Christopher D. Pfeiffer
Affiliation:
VA Portland Health Care System, Portland, OR, USA Department of Medicine, Oregon Health & Science University, Portland, OR, USA
Rabeeya Sabzwari
Affiliation:
Department of Infectious Diseases, Edward Hines Jr. VA Hospital, Hines, IL, USA Loyola University Medical Center, Maywood, IL, USA
Ahmed M. Salti
Affiliation:
VA Portland Health Care System, Portland, OR, USA College of Osteopathic Medicine of the Pacific – Northwest, Pomona, CA, USA
Danielle Tate
Affiliation:
St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA
Tammy Walkner
Affiliation:
Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
Andrew S. Webster
Affiliation:
Atlanta VA Medical Center, Decatur, GA, USA Emory University School of Medicine, Atlanta, GA, USA
Charlesnika T. Evans
Affiliation:
VA Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Robin L.P. Jump*
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA
*
Corresponding author: Robin L.P. Jump; Email: robin.jump@va.gov
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Abstract

Background:

To support Antimicrobial Stewardship programs (ASPs) as well as the clinical care of patients with infections, we disseminated and implemented a Videoconference Antimicrobial Stewardship Team (VAST) to connect multidisciplinary teams from rural Veterans Affairs (VA) medical centers with geographically distant ID experts. Here, we describe the clinical syndromes discussed and the response to recommendations made during VAST sessions.

Methods:

Between September 2021 to February 2024, eight ID consultants established VASTs with ten rural VAMCs, holding regularly scheduled videoconference sessions to discuss clinical cases and provide recommendations. Data were collected on patient demographics, clinical syndromes, and recommendations. Acceptance of recommendations within one week of each session was assessed via chart review. Six months after the intervention began, we conducted semi-structured interviews to assess participants’ perceptions of VASTs.

Results:

VASTs reviewed 626 cases involving 527 unique patients. Among 763 clinical syndromes discussed, the most common were infections of the respiratory (29%) or urinary tract (21%). Overall, VASTs made 973 recommendations, of which 71% were accepted. Of 570 recommendations related to antibiotics, 459 (80%) were accepted. Among 403 other recommendations, 235 (58%) were accepted. Interviews with participants indicated the importance of building trust and strong interpersonal relationships.

Conclusions:

VASTs effectively supported Antimicrobial Stewardship in rural VA medical centers (VAMCs) without local ID expertise. High acceptance rates, particularly for antibiotic-related recommendations, suggest that telehealth-enabled provider-to-provider models enhance stewardship efforts.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 47 , Issue 7 , July 2026 , pp. 710 - 717
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Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Copyright
© Department of Veterans Affairs, 2026

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