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A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers

  • Lauren D. Stevenson (a1), Richard E. Banks (a2), Krysttel C. Stryczek (a1), Christopher J. Crnich (a3) (a4), Emma M. Ide (a3), Brigid M. Wilson (a2), Roberto A. Viau (a5) (a6), Sherry L. Ball (a1) and Robin L.P. Jump (a2) (a5) (a6) (a7) (a8)...
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.

Copyright
Corresponding author
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
References
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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