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Effect of Communication Errors During Calls to an Antimicrobial Stewardship Program

  • Darren R. Linkin (a1) (a2) (a3) (a4) (a5) (a6), Neil O. Fishman (a1) (a2) (a4), J. Richard Landis (a3) (a7), Todd D. Barton (a1) (a2), Steven Gluckman (a1) (a2), Jay Kostman (a1) (a2) and Joshua P. Metlay (a1) (a3) (a4) (a7) (a8) (a5)...



To determine how inaccurate communication of patient data by clinicians in telephone calls to the prior-approval antimicrobial stewardship program (ASP) staff affects the incidence of inappropriate antimicrobial recommendations made by ASP practitioners.


A retrospective cohort design was used. The accuracy of the patient data communicated was evaluated against patients' medical records to identify predetermined, clinically significant inaccuracies. Inappropriate antimicrobial recommendations were defined having been made if an expert panel unanimously rated the actual recommendations as inappropriate after reviewing vignettes derived from inpatients' medical records.


The setting was an academic medical center with a prior-approval ASP.


All inpatient subjects of ASP prior-approval calls were eligible for inclusion.


Of 200 ASP telephone calls, the panel agreed about whether or not antimicrobial recommendations were inappropriate for 163 calls (82%); these 163 calls were then used as the basis for further analyses. After controlling for confbunders, inaccurate communication was found to be associated with inappropriate antimicrobial recommendations (odds ratio [OR], of 2.2; P = .03). In secondary analyses of specific data types, only inaccuracies in microbiological data were associated with the study outcome (OR, 7.5; P = .002). The most common reason panelists gave for rating a recommendation as inappropriate was that antimicrobial therapy was not indicated.


Inaccurate communication of patient data, particularly microbiological data, during prior-approval calls is associated with an increased risk of inappropriate antimicrobial recommendations from the ASP. Clinicians and ASP practitioners should work to confirm that critical data has been communicated accurately prior to use of that data in prescribing decisions.


Corresponding author

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1.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and healthcare costs. Clin Infect Dis 2006;42(suppl 2):S82S89.
2.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834844.
3.Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972978.
4.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.
5.John, JF Jr, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471485.
6.White, AC Jr, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230239.
7.Frank, MO, Batteiger, BE, Sorensen, SJ, et al. Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clin Perform Qual Health Care 1997;5:180188.
8.Gross, R, Morgan, AS, Kinky, DE, Weiner, M, Gibson, GA, Fishman, NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001;33:289295.
9.Shlaes, DM, Gerding, DN, John, JF Jr, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275291.
10.Lawton, RM, Fridkin, SK, Gaynes, RP, McGowan, JE Jr. Practices to improve antimicrobial use at 47 US hospitals: the status of the 1997 SHEA/IDSA position paper recommendations. Society for Healthcare Epidemiology of America/Infectious Diseases Society of America. Infect Control Hosp Epidemiol 2000;21:256259.
11.Linkin, DR, Paris, S, Fishman, NO, Metlay, JP, Lautenbach, E. Inaccurate communications in telephone calls to an antimicrobial stewardship program. Infect Control Hosp Epidemiol 2006;27:688694.
12.University of Pennsylvania Medical Center. University of Pennsylvania Medical Center guidelines for antibiotic use: commonly used anti-infectives and restriction categories. Available at: Accessed October 14, 2007.
13.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.
14.Kieszak, SM, Flanders, WD, Kosinski, AS, Shipp, CC, Karp, H. A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data. J Clin Epidemiol 1999;52:137142.
15.Stelfox, HT, Bates, DW, Redelmeir, DA. Safety of patients isolated for infection control. JAMA 2003;290:18991905.
16. Standards, practice guidelines, and statements developed and/or endorsed by the Infectious Diseases Society of America. Available at: Accessed May 26, 2006.
17.Rand Corporation. Available at: Accessed May 15, 2007.
18.Park, RE, Fink, A, Brook, RH, et al. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health 1986;76:766772.
19.Leape, LL, Hilborne, LH, Park, RE, et al. The appropriateness of use of coronary artery bypass graft surgery in New York State. JAMA 1993;269:753760.
20.Localio, AR, Berlin, JA, Ten Have, TR, Kimmel, SE. Adjustments for center in multicenter studies: an overview. Ann Intern Med 2001;135:112123.
21.Calfee, DP, Brooks, J, Zirk, NM, Giannetta, ET, Scheid, WM, Farr, BM. A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme. J Hosp Infect 2003;55 2632
22.Green, MJ, Farber, NJ, Ubel, PA, et al. Lying to each other: when internal medicine residents use deception with their colleagues. Arch Intern Med 2000;160:23172323.
23.Jagsi, R, Kitch, BT, Weinstein, DF, Campbell, EG, Hutter, M, Weissman, JS. Residents report on adverse events and their causes. Arch Intern Med 2005;165:26072613.
24.Evans, RS, Pestotnik, SL, Classen, DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998;338:232238.

Effect of Communication Errors During Calls to an Antimicrobial Stewardship Program

  • Darren R. Linkin (a1) (a2) (a3) (a4) (a5) (a6), Neil O. Fishman (a1) (a2) (a4), J. Richard Landis (a3) (a7), Todd D. Barton (a1) (a2), Steven Gluckman (a1) (a2), Jay Kostman (a1) (a2) and Joshua P. Metlay (a1) (a3) (a4) (a7) (a8) (a5)...


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