from the editor
Examining Variation Within Antimicrobial Stewardship Programs
Variation in practice is one of the perennial challenges in healthcare , and antimicrobial stewardship programs aren ’ t immune , as researchers at Intermountain Healthcare discovered when they conducted their survey to identify and stratify antimicrobial stewardship programs to study the effectiveness of these models to best enhance patient care and reduce the rise of antibiotic-resistant superbugs .
“ We brought together antimicrobial stewardship leaders from around the country to better understand both the structures and functions of their programs ,” says researcher Whitney Buckel , PharmD , an antimicrobial stewardship pharmacist manager at Intermountain Healthcare .
“ You could find 50 different marathon training programs that would all get you to the finish line , but they may not all be efficient , or applicable to you . It ’ s the same with antimicrobial stewardship programs ,” adds researcher Eddie Stenehjem , MD , medical director of antibiotic stewardship at Intermountain Healthcare . “ We wanted to get a better idea of what is happening out in mostly in-patient healthcare settings , so that we can start determining which programs are best suited to which kind of healthcare systems .”
The study , published in a recent issue of the journal Clinical Infectious Diseases , surveyed 20 healthcare systems , including Kaiser Permanente , the Mayo Clinic and Veterans Health Administration . Program leaders were asked about key aspects of their system or network ’ s current antibiotic stewardship structure and function . Researchers found four categories of programs :
➊ Collaborative Model ( 15 percent ): These programs developed organically with no formal structure and are run by committees with limited accountability . Through this model , participation by sites is voluntary , and antimicrobial stewardship goals are set by individual sites , rather than at the system level .
➋ Centrally Coordinated Model ( 30 percent ): These programs have a formal written structure and committee with some level of system accountability . This model often forms organically at first but also has committee-led system stewardship initiatives , systemwide goals coordinated through a central committee ( and may be augmented by local goals ), data resources that are often prioritized by the committee .
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You could find 50 different marathon training programs that would all get you to the finish line , but they may not all be efficient , or applicable to you .
It ’ s the same with antimicrobial stewardship programs .” — Eddie Stenehjem , MD
➌ Centrally Led Model ( 40 percent ): These programs have a formal system of antimicrobial stewardship leaders , and system accountability with system-level resources . Goals are set by leaders at the system level ( and may be augmented by local goals ), with system leaders responsible for standardized data across all sites , and with benchmarking prioritized .
➍ Collaborative , Consultative Network Model ( 10 percent ). These program , where antimicrobial stewardship leaders outside the organization serve as consultants , mentors , or members in collaboration with on-site leaders , allow sites to participate in and receive support from a network . This model also has site-specific mentoring , goals , stewardship and tools adopted from external sites ; data technology and communication developed locally or through the system ’ s network ; and subject-matter expertise and education provided by external leaders as well .
Next , researchers hope to use these categories to start studying which models are most effective for which kinds of healthcare systems . This study also focused largely on practices for in-patient care , and researchers hope to expand their work to antibiotic prescribing activity at in out-patient settings , like urgent care clinics and doctor ’ s offices .
Until next month , bust those bugs ! Kelly M . Pyrek Editor & Publisher kelly @ healthcarehygienemagazine . com
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