Michigan Hospitals Collaborate to Meet Stewardship Requirements

In 2017, The Joint Commission implemented requirements that US hospitals have stewardship programs in order to receive accreditation. While this increased the number of programs, some smaller non-academic hospitals have had limited success in executing resource-intensive aspects of stewardship.

In order to overcome barriers to stewardship implementation, some hospitals join or establish regional initiatives.

Authors of a newly published manuscript in Open Forum Infectious Diseases surveyed the 46 hospitals participating in Michigan Hospital Medicine Safety Consortium (HMS) in the leadup to The Joint Commission’s stewardship requirement in order to evaluate contemporary practices and needs.

From September 30, 2016 to November 7, 2016, investigators emailed surveys to participating hospitals. Surveys were completed by a data abstractor, usually a nurse in quality review, at each institution. Of the 46 HMS participating hospitals, only 2 small community hospitals did not have an antibiotic stewardship program in place.

Survey content concerned the 2014 US Centers for Disease Control and Prevention (CDC) elements action, tracking, reporting, and education.

The majority of institutions reported collaboration with CDC-defined key support groups, though partnerships with nursing (17 of 46; 37%) and information technology (31 of 46; 67%).

While all programs used at least 1 CDC-recommended action element, antibiotic time-outs were only used in 6 (13%) of hospitals. And while 80% of institutions had some policy in place related to antibiotic documentation, only 8 (17%) required documentation of intended duration. In addition, only 24 of the 46 hospitals (52%) reported monitoring compliance with documentation.

Further, only 8 hospitals had a process by which to review outpatient antibiotic orders before discharge.

Rapid diagnostic tests were used by 31 (67%) hospitals, but these testes were regularly reviewed to optimize antibiotic use in only 16 (35%) hospitals. Similarly, 98% of hospitals reported syndrome-specific recommendations, but only 39% monitored adherence with such recommendations.

It appears from results gathered by the survey that improvements have been made through the pooling of resources made possible by collaborations like HMS, but that there is a gap between meeting official guidelines or making improvements in antibiotic use and maximizing the potential of stewardship programs.

“Though nearly all hospitals met the CDC’s 2014 action core element (ie implementing at least one recommended stewardship action), a deeper dive found that adherence to interventions, policies, and recommendations were rarely monitored. Limited resources and the noted lack of collaboration with information technology may contribute,” study authors wrote.

Results of the survey are already being considered within the hospitals surveyed, with new interventions starting in 2017. Because nearly half of the hospitals surveyed lack syndrome-specific interventions, the investigators from the study now conduct quarterly in-person meetings on the subject. In addition, the study team provides other services such as mechanisms for evaluating antibiotic use at discharge.

“The results of this multiyear effort are underway, but preliminary results are promising, and may inform similar stewardship initiatives elsewhere. Specifically, other initiatives should focus on providing concrete, actionable, and benchmarked hospital data,” the study authors wrote of their ongoing work in the HMS.