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Staffing and workflow of an interactive telehealth Antimicrobial Stewardship program with the Veterans Health Administration

Published online by Cambridge University Press:  04 May 2026

Amanda Vivo Open the ORCID record for Amanda Vivo [Opens in a new window] ,
Geneva M. Wilson Open the ORCID record for Geneva M. Wilson [Opens in a new window] ,
Dustin D. French ,
Taissa A. Bej Open the ORCID record for Taissa A. Bej [Opens in a new window] ,
Brigid Wilson Open the ORCID record for Brigid Wilson [Opens in a new window] ,
Corinne Kowal Open the ORCID record for Corinne Kowal [Opens in a new window] ,
Amelia Milner Open the ORCID record for Amelia Milner [Opens in a new window] ,
Carla Amundson Open the ORCID record for Carla Amundson [Opens in a new window] ,
Kristina Bajema Open the ORCID record for Kristina Bajema [Opens in a new window]  and
Jason P. Burnham Open the ORCID record for Jason P. Burnham [Opens in a new window]
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Amanda Vivo
Affiliation:
VA Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, USA
Geneva M. Wilson
Affiliation:
VA Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, USA Department of Preventive Medicine, Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, USA
Dustin D. French
Affiliation:
VA Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, USA Departments of Ophthalmology and Medical Social Sciences, Northwestern University, USA
Taissa A. Bej
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, USA
Brigid Wilson
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, USA Department of Medicine, Case Western Reserve University School of Medicine, USA
Corinne Kowal
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, USA
Amelia Milner
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, USA
Carla Amundson
Affiliation:
Minneapolis Veterans Affairs Health Care System, USA
Kristina Bajema
Affiliation:
Portland VA Health Care System, USA Oregon Health & Science University, USA
Jason P. Burnham
Affiliation:
St. Louis Veterans Affairs Medical Center, USA Washington University in St. Louis School of Medicine, USA
Christopher Crnich
Affiliation:
William S Middleton Memorial Veterans Hospital, USA University of Wisconsin School of Medicine and Public Health, USA
Lauren Epstein
Affiliation:
Atlanta VA Medical Center, USA Emory University School of Medicine, USA
Daniel J. Livorsi
Affiliation:
Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, USA University of Iowa Carver College of Medicine, USA
Muthu Narayan
Affiliation:
Minneapolis Veterans Affairs Health Care System, USA University of Minnesota, Minneapolis, USA
Christopher Pfeiffer
Affiliation:
Portland VA Health Care System, USA Oregon Health & Science University, USA
Rabeeya Sabzwari
Affiliation:
Department of Infectious Diseases, Edward Hines Jr. VA Hospital, USA Loyola University Medical Center, USA
Ahmed Salti
Affiliation:
Portland VA Health Care System, USA Current Affiliation: College of Osteopathic Medicine of the Pacific, USA
Danielle Tate
Affiliation:
St. Louis Veterans Affairs Medical Center, USA
Tammy Walkner
Affiliation:
Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, USA
Andrew Webster
Affiliation:
Atlanta VA Medical Center, USA Emory University School of Medicine, USA
Robin Jump
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, USA Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs (VA) Pittsburgh Healthcare System, USA
Charlesnika Evans*
Affiliation:
VA Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, USA Department of Preventive Medicine, Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, USA
*
Corresponding author: Charlesnika Evans; Email: charlesnika.evans@va.gov
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Abstract

Objective:

Describe the workload associated with using telehealth to support Antimicrobial Stewardship efforts at Veterans Affairs Medical Centers (VAMCs) without local infectious diseases (ID) expertise.

Design:

A mixed-methods process assessment to evaluate workload and workflow associated with Videoconference Antimicrobial Stewardship Teams (VASTs).

Setting and Participants:

Rural VAMC champions paired with ID consultants at geographically distant VAMCs to form VASTs.

Methods:

Total workload estimates were based on time that champions and ID consultants allocated to VAST activities. Clinical Procedural Terminology (CPT) codes were used to estimate the workloads for clinical encounters. Role-based process maps were developed to understand variation in implementation by VAMC.

Results:

The average workload that champions and ID consultants allocated to VAST activities was 6.7% (range 1.0%–20.0%) and 8.4% (range 2.0%–12.5%) full-time equivalents (FTEs), respectively. Clinical encounters completed by ID consultants contributed an average of 1.4% (range < 0.01%–2.5%) FTEs to the workload. The average proportion of FTEs required to sustain VASTs was 13.0% (range 3.0%–31.6%). Process maps showed four phases common to each VAST’s workflow: case identification, meeting preparation, team meeting, and documentation. The tasks associated with each phase varied between VASTs. Champions carried out most tasks related to case finding and meeting preparation; the ID consultants completed most documentation tasks.

Conclusions:

The distribution of tasks within and among the VASTs indicated opportunities to improve workflow efficiency. Investing <12.5% of the FTE allocated to VA Antimicrobial Stewardship programs to support the time of an ID consultant from another VAMC can help rural VAMCs achieve staffing sustainability.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 47 , Issue 7 , July 2026 , pp. 718 - 723
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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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