In 2007, guidelines were published recommending the development of formal antimicrobial stewardship programs (ASP) to optimize clinical outcomes, minimize the emergence of resistant organisms, and reduce costs. Studies suggest that these programs can be self sustaining while improving quality, but hospital administrators have been slow to invest in ASP.
To obtain and analyze baseline local data to demonstrate to administrators the value of institutionally funding an infectious disease physician and dedicated pharmacist for a formal ASP.
Methods: Prior to granting funding for a prospective audit ASP, administration wanted a formal analysis. We created an ASP development team to determine: 1) the degree of suboptimal prescription practices in our academic children’s hospital, 2) the causes and consequences of the practices, 3) initial improvement targets and potential impact, and 4) cost/benefit ratio. The investigation team included two ID physicians, two pharmacists, a data analyst and a process improvement coordinator. We analyzed antibiotic usage data from pharmacy, financial and medical records, and we reviewed published literature. The findings were presented to the quality improvement council and hospital executives.
Results: Ten areas of suboptimal practice were identified, including: use of antimicrobials in viral disease, inappropriate use of biologics, failure to discontinue antibiotics, inappropriate empiric therapy based on local epidemiologic data, use of high cost antibiotics, inappropriate dosing, delay in IV to oral transition, failure to order antibiotics when appropriate, drug-bug mismatch, and increasing C. difficile and multidrug resistant organisms. For each of these, we assessed current practice, the extent of the problem, and potential solutions. Cost analysis of a limited sample of suboptimal practices revealed $375,000 in unnecessary charges and a minimum of $ 100,000 in unrecovered costs. After presentation of the investigation results, the executive team approved funding for the program during a time of fiscal austerity. Initially a portion of revenue from antimicrobial charges was dedicated to ASP funding.
Conclusions: Suboptimal antibiotic prescribing practices are common. Enlisting the support of medical leaders and quality improvement teams for careful analysis of local expenditures and use patterns and may provide the objective data and the internal support needed to convince administrators to invest in an ASP. A formal development team can efficiently identify and analyze data and garner support for funding an ASP.