scholarly journals 154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Deepika Sivakumar ◽  
Shelbye R Herbin ◽  
Raymond Yost ◽  
Marco R Scipione
Keyword(s):  
Retrospective Review ◽  
Bacterial Pneumonia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Percent Change ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Time Periods ◽  
The Impact

Abstract Background Inpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic. Methods We conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated. Results An increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves. Figure 1. Antibiotic Use 01/2019 to 04/2019 Conclusion Antibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia. Disclosures All Authors: No reported disclosures

Use of Longitudinal Surveillance Data to Assess the Effectiveness of Infection Control in Critical Care

2009 ◽  
Vol 30 (11) ◽  
pp. 1109-1112 ◽  
Author(s):  
John W. Ahern ◽  
W. Kemper Alston
Keyword(s):  
Infection Control ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Surveillance Data ◽  
Simple Method ◽  
Academic Medical ◽  
Multidrug Resistant Organisms ◽  
The Impact

A simple method for quantifying nosocomial infection and colonization with multidrug-resistant organisms is described. This method is applied to the intensive care unit of an academic medical center where longitudinal surveillance data have been used to assess the impact of infection control interventions and antibiotic use.

scholarly journals The Impact of Biofire Filmarray Respiratory Panel on Antibiotic Usage in the Emergency Department at an Academic Medical Center

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S354-S354
Author(s):  
Meera Mehta ◽  
Douglas Slain ◽  
Lisa Keller ◽  
P Rocco Lasala
Keyword(s):  
Emergency Department ◽  
Respiratory Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Usage ◽  
Academic Medical ◽  
Days Of Therapy ◽  
The Impact ◽  
Pcr Test ◽  
Viral Respiratory

Abstract Background Biofire respiratory panel is a multiplex PCR test designed to detect 17 pathogens within 1 hour. It has greater sensitivity, specificity, and number of pathogens detected compared with older testing methods. The aim of this research was to evaluate the impact of Biofire respiratory panel on antibiotic usage in the emergency department (ED) of an academic medical center. Methods This was an observational chart review. Patients with positive RSV or influenza rapid antigen test or PCR test, and patients with a positive Biofire test were included. RSV or influenza tests were reviewed from July to December 2015, and Biofire tests were reviewed from July to December 2016. The primary outcome was to evaluate the duration of antibiotic therapy in patients with viral respiratory infections diagnosed with RSV and influenza rapid antigen and PCR testing compared with Biofire viral respiratory panel. Secondary outcomes included virus type, antibiotic prescription rates on discharge, number of addmissions, procalcitonin levels, and oseltamivir usage. Results In 2016, 67% (105/155) of biofire tests were positive. The most common pathogen was rhinovirus and enterovirus (42%). Of the positive results, 23/105 (22%) received antibiotics with 6 patients having antibiotics discontinued within 72 hours. Another 6 patients had bacterial coinfections. A total of 18/105 (17%) received antibiotic prescriptions on discharge. Median days of therapy (DOT) in hospital was 1 day and median DOT for prescriptions was 8.5 days. There were 5 procalcitonin tests and no oseltamivir usage. Overall 38/105 (36%) patients were admitted to inpatient. In 2015, 3% (20/1313) of RSV (14) and influenza (6) rapid antigen and PCR tests were positive. A total of 5/20 (25%) patients received antibiotics, with 3/20 (15%) patients receiving a prescription for outpatient antibiotics. Median DOT in the hospital was 3 days and median DOT for prescriptions was 10 days. There were 2 procalcitonin tests and 2 cases used oseltamivir. Overall 19 patients were admitted. Conclusion Antibiotics are witheld in the majority of patients with positive Biofire testing. Most patients were treated with supportive care measures only. Biofire continues to be a useful tool to identify candidates for antibiotic avoidance in the ED at our institution. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s169
Author(s):  
Rebecca Choudhury ◽  
Ronald Beaulieu ◽  
Thomas Talbot ◽  
George Nelson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Units ◽  
Antibiotic Utilization ◽  
Academic Medical ◽  
Level Data ◽  
Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

scholarly journals Alcohol Hand Rub Significantly Reduces Overall Bacterial Bioburden on Stethoscopes in a Real-World Clinical Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s114-s115
Author(s):  
Alexandra Johnson ◽  
Bobby Warren ◽  
Deverick John Anderson ◽  
Melissa Johnson ◽  
Isabella Gamez ◽  
...  
Keyword(s):  
Real World ◽  
Medical Center ◽  
Academic Medical Center ◽  
Randomized Study ◽  
Healthcare Providers ◽  
Clinical Workflow ◽  
Provider Type ◽  
Academic Medical ◽  
Rn Students ◽  
The Impact

Background: Stethoscopes are a known vector for microbial transmission; however, common strategies used to clean stethoscopes pose certain barriers that prevent routine cleaning after every use. We aimed to determine whether using readily available alcohol-based hand rub (ABHR) would effectively reduce bacterial bioburden on stethoscopes in a real-world setting. Methods: We performed a randomized study on inpatient wards of an academic medical center to assess the impact of using ABHR (AlcareExtra; ethyl alcohol, 80%) on the bacterial bioburden of stethoscopes. Stethoscopes were obtained from healthcare providers after routine use during an inpatient examination and were randomized to control (no intervention) or ABHR disinfection (2 pumps applied to tubing and bell or diaphragm by study personnel, then allowed to dry). Cultures of the tubing and bell or diaphragm were obtained with premoistened cellulose sponges. Sponges were combined with 1% Tween20-PBS and mixed in the Seward Stomacher. The homogenate was centrifuged and all but ~5 mL of the supernatant was discarded. Samples were plated on sheep’s blood agar and selective media for clinically important pathogens (CIPs) including S. aureus, Enterococcus spp, and gram-negative bacteria (GNB). CFU count was determined by counting the number of colonies on each plate and using dilution calculations to calculate the CFU of the original ~5 mL homogenate. Results: In total, 80 stethoscopes (40 disinfection, 40 control) were sampled from 46 physicians (MDs) and MD students (57.5%), 13 advanced practice providers (16.3%), and 21 nurses (RNs) and RN students (26.3%). The median CFU count was ~30-fold lower in the disinfection arm compared to control (106 [IQR, 50–381] vs 3,320 [986–4,834]; P < .0001). The effect was consistent across provider type, frequency of recent usual stethoscope cleaning, age, and status of pet ownership (Fig. 1). Overall, 26 of 80 (33%) of stethoscopes harbored CIP. The presence of CIP was lower but not significantly different for stethoscopes that underwent disinfection versus controls: S. aureus (25% vs 32.5%), Enterococcus (2.5% vs 10%), and GNB (2.5% vs 5%). Conclusions: Stethoscopes may serve as vectors for clean hands to become recontaminated immediately prior to performing patient care activities. Using ABHR to clean stethoscopes after every use is a practical and effective strategy to reduce overall bacterial contamination that can be easily incorporated into clinical workflow. Larger studies are needed to determine the efficacy of ABHR at removing CIP from stethoscopes as stethoscopes in both arms were frequently contaminated with CIP. Prior cleaning of stethoscopes on the study day did not seem to impact contamination rates, suggesting the impact of alcohol foam disinfection is short-lived and may need to be repeated frequently (ie, after each use).Funding: NoneDisclosures: NoneDisclosures: NoneFunding: None

Abstract 16125: Impact of COVID-19 on Echocardiography Volume at a Large Academic Medical Center

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Merilyn S Varghese ◽  
Jordan B Strom ◽  
Sarah Fostello ◽  
Warren J Manning
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Hospital Systems ◽  
The Impact ◽  
At Home

Introduction: COVID-19 has significantly impacted hospital systems worldwide. The impact of statewide stay-at-home mandates on echocardiography volumes is unclear. Methods: We queried our institutional echocardiography database from 6/1/2018 to 6/13/2020 to examine rates of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) prior to and following the COVID-19 Massachusetts stay-at-home order on March 15, 2020. Results: Among 36,377 total studies performed during the study period, mean weekly study volume dropped from 332 + 3 TTEs/week, 30 + 1 SEs/week, and 21 + 1 TEEs/week prior to the stay-at-home order (6/1/2018-3/15/2020) to 158 + 13 TTEs/week, 8 + 2 SEs/week, and 8 + 1 TEEs/week after (% change, -52%, -73%, and -62% respectively, all p < 0.001 when comparing volume prior to March 15 versus after). Weekly TTEs correlated strongly with hospital admissions throughout the study period (r = 0.93, 95% CI 0.89-0.95, p < 0.001) ( Figure ). Outpatient TTEs declined more than inpatient TTEs (% change, -74% vs. -39%, p <0.001). As of 3 weeks following the cessation of the stay-at-home order, TTE, SE, and TEE weekly volumes have increased to 73%, 66%, and 81% of pre-pandemic levels, respectively. Conclusions: Echocardiography volumes fell precipitously following the Massachusetts stay-at-home order, strongly paralleling declines in overall hospitalizations. Outpatient TTEs declined more than inpatient TTEs. Despite lifting of the order, echocardiography volumes remain substantially below pre-pandemic levels. The impact of the decreased use of echocardiographic services on patient outcomes remains to be determined.

scholarly journals 1116. Impact of Antimicrobial Stewardship Incentive Goals for Pharmacists on Overall Antibiotic Use and Appropriate Duration of Therapy in Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S397
Author(s):  
Matthew A Miller ◽  
Mattie Huffman ◽  
Nichole Neville ◽  
Misha Huang ◽  
Gerard Barber
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Group Performance ◽  
Respiratory Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Days Of Therapy ◽  
Essential Resource ◽  
Tract Infections

Abstract Background Urinary tract (UTI), skin and soft tissue, and respiratory infections are among the most frequently reported indications for antibiotics, such that focusing stewardship efforts here would expectedly have dramatic effects. Antimicrobial stewardship (AMS) programs vary in structure and available resources. At the University of Colorado Hospital, a 740-bed academic medical center, dedicated resources for AMS are limited to a pharmacist, pharmacy resident, and physician; however, there is a large clinical pharmacist group. For the past 2 years, pharmacy management incorporated AMS targets as group goals tied to performance bonuses. Methods This is a descriptive report utilizing incentives to achieve AMS goals. The first goal (July 1, 2016 to June 30, 2017) set out to reduce inpatient antibiotic use by 10%. The second goal (July 1, 2018 to June 30, 2018) was a 10% reduction in median antibiotic duration for UTIs. The AMS team provided guidelines, education, and oversight throughout target periods. Antibiotic use was calculated as days of therapy (DOT) per 1000 patient-days. Data related to UTI treatment was collected retrospectively on a quarterly basis. This was compared with baseline data previously collected during a statewide hospital stewardship collaborative project. Results During the first period, overall antibiotic use declined from 497 to 403 DOT per 1000 patient-days (18.9%), and broad-spectrum antibiotic use declined 22%. During the second period, 30 patient charts were reviewed quarterly, and the median UTI duration declined from 10 to 7 days (P = 0.002). The most common UTI diagnoses were similar between periods with complicated cystitis and pyelonephritis comprising 60–70% of cases. The 30-day readmission rate was not different between the baseline and goal period, 11% vs. 6% respectively (P = 0.18). Conclusion The use of group pharmacist goals tied to annual performance bonuses was effective in achieving AMS goals at our institution. In larger facilities with fewer dedicated AMS personnel, clinical pharmacists covering ward and intensive care units are an essential resource to achieving AMS goals. Group performance incentives may be a feasible strategy to generate interest and motivation to achieve AMS program goals. Disclosures All authors: No reported disclosures.

scholarly journals The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

2018 ◽  
Vol 10 (5) ◽  
pp. 583-586 ◽  
Author(s):  
Matthew Gorgone ◽  
Brian McNichols ◽  
Valerie J. Lang ◽  
William Novak ◽  
Alec B. O'Connor
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Medical Providers ◽  
Procedural Training ◽  
Academic Medical ◽  
Attending Physician ◽  
Attending Physicians ◽  
The Impact ◽  
Training Opportunities

ABSTRACT Background  Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician–led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective  We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods  We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results  Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions  The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

The impact of formulary restriction on the relative consumption of carbapenems in intensive care units at an academic medical center

2019 ◽  
Vol 40 (9) ◽  
pp. 1056-1058
Author(s):  
Jacob W. Pierce ◽  
Andrew Kirk ◽  
Kimberly B. Lee ◽  
John D. Markley ◽  
Amy Pakyz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Surgical Intensive Care ◽  
Academic Medical ◽  
The Impact ◽  
Formulary Restriction

AbstractAntipseudomonal carbapenems are an important target for antimicrobial stewardship programs. We evaluated the impact of formulary restriction and preauthorization on relative carbapenem use for medical and surgical intensive care units at a large, urban academic medical center using interrupted time-series analysis.

scholarly journals A Qualitative Exploration to Understand Hospitalists’ Attitude Toward the Patient Experience Scoring System

2020 ◽  
Vol 7 (6) ◽  
pp. 1036-1043 ◽  
Author(s):  
Ankur Segon ◽  
Yogita Segon ◽  
Vivek Kumar ◽  
Hirotaka Kato
Keyword(s):  
Scoring System ◽  
Medical Center ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
Semistructured Interview ◽  
Academic Medical ◽  
Knowledge And Attitude ◽  
Patient’S Perception ◽  
The Impact ◽  
Hcahps Survey

Patient’s perception of their inpatient experience is measured by the Center for Medical Services’ (CMS) administered Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) survey. There is scant existing literature on physicians’ perceptions toward the HCAHPS scoring system. Understanding hospitalist knowledge and attitude toward the HCAHPS survey can help guide efforts to impact HCAHPS survey scores by improving the patient’s perception of their hospital experience. The goal of this study is to explore hospitalists’ knowledge and perspective of the physician communication domain of the HCAHPS survey at an academic medical center. Seven hospitalists at an academic medical center were interviewed for this report using a semistructured interview. Thematic analysis approach was used to analyze data. Open, line-by-line coding was performed on all 7 transcripts. Categories were derived in an inductive fashion. Categories were refined using the techniques of constant comparison and axial coding. We generated themes reflecting hospitalists’ knowledge of the HCAHPS scoring system, their perception of the HCAHPS scoring system and the impact of the HCAHPS scoring system on their practice. While hospitalists acknowledged physician–patient communication is a challenging area to study, they are unlikely to embrace the feedback provided by HCAHPS surveys. There is a need to deploy tactics that provide timely and actionable feedback to providers on their bedside communication skills.

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