Are Residents the Lost Stakeholders in Stewardship?

As antimicrobial stewardship is becoming a critical element of improving patient care, a team of investigators from UPMC Mercy Hospital and UMPC St. Margaret Hospital in Pittsburgh, Pennsylvania, have noticed that perhaps some stakeholders are underrepresented in stewardship programs.

According to guidelines published by the Infectious Disease Society of America in 2016, antimicrobial stewardship programs should be led by an infectious disease physician and infectious disease pharmacists with additional stewardship training. However, most stewardship programs feature additional stakeholders, including department representatives from Infection Control, Microbiology, Hospitalists, Nursing, and Hospital Administration, the investigators note.

The study team noticed that medical residents are 1 of the underrepresented stakeholder groups, that have the potential to play a critical role in the growth of stewardship programs and very few programs have a Resident Champion Program (RCP).

Therefore, the investigators designed a survey to evaluate the opinions and perceptions of stewardship programs by Internal Medicine and Family Medicine residents. The findings of the survey were presented in a poster session at the Making a Difference in Infectious Diseases 2019 (MAD-ID) annual meeting.

In an exclusive interview at MAD-ID, Contagion® spoke with Brandon J. Smith, MD, PharmD, the presenter of the poster.

The 10-question survey was distributed to 133 residents across 3 hospitals within a large health system. The investigators note that, “interactions between residents and ASPs at a hospital with an RCP were compared to two hospitals without an RCP.”

In total, 47 residents completed the survey (24 RCP, 23 non-RCP). All 24 RCP residents were aware of their hospital’s stewardship program, compared to 9 out of 23 (39.1%) non-RCP residents (p<0.001). Additionally, at the RCP, 18 out of 24 (75%) residents were aware of the RC.

Among residents aware of the stewardship program, 20 of the 24 (83.3%) RCP residents reported interactions with ASP versus 3/9 (33.3%) non-RCP residents (p=0.007). At the RCP, 23 out of 24 (95.8 %) residents knew at least 1 member of the stewardship program team compared to 2 out of 9 (22.2%) non-RCP residents (p<0.001). Further, increased satisfaction with ASP recommendations was reported by RCP residents, with 12 out of 24 (50%) rating satisfaction as exceeds their expectation or outstanding, and 11 out of 23 (47.9%) rating as acceptable; whereas all 9 non-RCP residents responded with an acceptable rating (p=0.027).

The authors conclude that in order for stewardship programs to be successful they must be supported by all of the health system’s stakeholders. Residents can often be overlooked as stakeholders but they are “frontline providers at a formative stage of their developing medical career,” the authors write, elaborating that “this presents a prime opportunity to educate and foster good stewardship practice behaviors that they will utilize throughout their careers.”

The authors are hopeful that the study may provide a foundation for the inclusion of an RC in hospital antimicrobial stewardship programs, as these individuals can be a liaison to facilitate more frequent interactions and enhanced perception of stewardship teams.

The poster “The Lost Stakeholders in Antimicrobial Stewardship” was presented on Thursday, May 9, 2019 at MAD-ID 2019 in Orlando, Florida.