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Saturday, March 20, 2010: 3:00 PM
International North (Hyatt Regency Atlanta)
Background: Antimicrobial Stewardship Programs (ASP) are effective in reducing the use and costs of antimicrobials. We are presenting the outcomes after the discontinuation of a successful ASP at a major tertiary care center in favor of a plan to use the resources to increase the penetration of infectious disease consults throughout the medical center.
Objective: Describe the results of the ASP in a large tertiary care academic medical center before, during the years of the intervention and after it was discontinued.
Methods: Monitor the quarterly and yearly utilization costs in dollars of antimicrobials by Fiscal Year (FY), (July 1-June 30), before initiation of the program (FY01), during the program (FY02-FY08) and for the year after the program was discontinued (FY09). Defined Daily Doses (DDDs) per 1000 patient days and quality parameters such as length of stay, unplanned readmissions and mortality were also tracked. Central to the antimicrobial stewardship program was the antimicrobial monitoring team consisting of a Pharm D (80% effort) and an Infectious Disease trained physician (25-50% effort) for daily real time monitoring of patients on antimicrobials and education of the prescribers.
Results: From the baseline year (FY01) antimicrobial utilization costs decreased from $7,774,588 to $4,776,663 (FY08). The majority of the decrease occurred in the first 3 years and costs were relatively stable from FY05- FY08. However, this resulted in over a 17 million dollar cumulative savings, less expenses, over this 7 year period of time. In FY09, after the program was discontinued, antimicrobial utilization costs increased over a million dollars from $4,776,663 to $5,869,764 (23%) compared to FY08. The increase in costs were higher each quarter of FY09 compared to the immediately preceding quarter. Those antimicrobials with the highest dollar increase included piperacillin/tazobactam (up $461,460 or 33%), linezolid ($156,120 or 45%), daptomycin ($151,350, 147%) and voriconazole (up $104,878 or 26%). The carbapenems as a class increased $143,556 or 35.4%. Overall, DDDs increased minimally, 4.8%, but increased 26.8% for the above antimicrobials. There were no significant changes in the quality parameters.
Conclusions: The Antimicrobial Stewardship Program using an antimicrobial monitoring team for real time monitoring and education was highly successful. Discontinuation of the program resulted in higher costs for the medical center, particularly from the increase use of broad spectrum and/or more expensive antibacterial agents. Increasing infectious disease consults may be valuable for clinical reasons, but not at the expense of the antimicrobial monitoring team.
Objective: Describe the results of the ASP in a large tertiary care academic medical center before, during the years of the intervention and after it was discontinued.
Methods: Monitor the quarterly and yearly utilization costs in dollars of antimicrobials by Fiscal Year (FY), (July 1-June 30), before initiation of the program (FY01), during the program (FY02-FY08) and for the year after the program was discontinued (FY09). Defined Daily Doses (DDDs) per 1000 patient days and quality parameters such as length of stay, unplanned readmissions and mortality were also tracked. Central to the antimicrobial stewardship program was the antimicrobial monitoring team consisting of a Pharm D (80% effort) and an Infectious Disease trained physician (25-50% effort) for daily real time monitoring of patients on antimicrobials and education of the prescribers.
Results: From the baseline year (FY01) antimicrobial utilization costs decreased from $7,774,588 to $4,776,663 (FY08). The majority of the decrease occurred in the first 3 years and costs were relatively stable from FY05- FY08. However, this resulted in over a 17 million dollar cumulative savings, less expenses, over this 7 year period of time. In FY09, after the program was discontinued, antimicrobial utilization costs increased over a million dollars from $4,776,663 to $5,869,764 (23%) compared to FY08. The increase in costs were higher each quarter of FY09 compared to the immediately preceding quarter. Those antimicrobials with the highest dollar increase included piperacillin/tazobactam (up $461,460 or 33%), linezolid ($156,120 or 45%), daptomycin ($151,350, 147%) and voriconazole (up $104,878 or 26%). The carbapenems as a class increased $143,556 or 35.4%. Overall, DDDs increased minimally, 4.8%, but increased 26.8% for the above antimicrobials. There were no significant changes in the quality parameters.
Conclusions: The Antimicrobial Stewardship Program using an antimicrobial monitoring team for real time monitoring and education was highly successful. Discontinuation of the program resulted in higher costs for the medical center, particularly from the increase use of broad spectrum and/or more expensive antibacterial agents. Increasing infectious disease consults may be valuable for clinical reasons, but not at the expense of the antimicrobial monitoring team.