Stewardship-Led Communication Improves Outcomes for Patients With Positive Cultures

The overuse of antibiotics can cause substantial clinical and financial burdens on health care systems in addition to patients and their families. The recognition of these prevalent burdens has led to the rise of antimicrobial stewardship programs in health systems across the globe.

In a Research Snapshot Theater presentation at the Society of Critical Care Medicine’s 48th Critical Care Congress, a team of investigators from Saint Luke’s Hospital in Kansas City, Missouri, presented their findings from a study focusing on whether the integration of a stewardship program with rapid identification technologies improved outcomes for hospitalized patients with positive blood cultures.

In 2015, the Antimicrobial Stewardship Program was launched at Saint Luke’s Hospital, and 2 new rapid diagnostic microbiology technologies were simultaneously introduced. The rapid diagnostic technologies significantly decreased the time from culture collection of pathogen identification.

Beginning in 2016, the microbiology staff at Saint Luke’s began sharing information about positive blood cultures to a member of the stewardship program team or an on-site pharmacist. The stewardship member or pharmacist would then interpret the results of the culture, evaluate information specific to the patient, and communicate culture and treatment information to the physician.

“The goal of this process change was to leverage the expertise of [stewardship] members or [Saint Luke’s] pharmacists to maximize outcomes for patients, streamline communication, and decrease unnecessary antimicrobial use,” the investigators wrote in the abstract.

The team also notes that the procedure change was intended to minimize the interruptions to the health system’s nurses in order to prioritize more time to patient care.

The investigators compared outcome measures from patients following the procedure change with pre-intervention groups who had positive cultures between August and December 2014.

The primary outcomes of the study included time to appropriate therapy and optimal antimicrobial therapy. While the secondary outcomes were numerous, the investigators focused on clinical, process, and fiscal impacts of the updated blood culture communication process.

The results of the study indicate that there were no differences found in time to appropriate therapy between 2014 and 2016 (-15.1 vs. -16.6 hours, p=0.079). The time to optimal therapy was 9.2 hours shorter in 2016 (p=0.004).

In regard to fiscal burdens, the investigators observed a trend in reduced inpatient and antimicrobial costs in 2016, estimating that $110,000 was saved as a result of drug optimization alone.

Surveys of the Saint Luke’s physicians found that the process improved communication in the health system and brought about shared-decision making processes resulting in an improvement in patient care.

The investigators concluded that a stewardship program-guided blood culture communication process for patients with bacteremia demonstrated the ability to shorten the amount of time required to reach optimal therapy, as well as support physicians in decision making on lab data, and improve the care the clinicians provided to patients.

The presentation, “Influencing outcomes by implementing rapid diagnostics and antimicrobial stewardship for bacteremia,” was presented on Monday February 18, 2019, at the at the Society of Critical Care Medicine’s 48^th Critical Care Congress in San Diego, California.