scholarly journals 153Implementation of a Provider-Based Antimicrobial Stewardship Strategy at a Long Term Acute Care Hospital (LTACH) and Inpatient Physical Medicine and Rehabilitation (PMR) Facility

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S75-S75
Author(s):  
Kiri Rolek ◽  
Naasha Talati ◽  
Shawn Binkley ◽  
Daniel Timko ◽  
Steven Morgan ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Physical Medicine ◽  
Physical Medicine And Rehabilitation

Antimicrobial Stewardship in a Long-Term Acute Care Hospital Using Offsite Electronic Medical Record Audit

2016 ◽  
Vol 37 (4) ◽  
pp. 433-439 ◽  
Author(s):  
Kirthana Beaulac ◽  
Silvia Corcione ◽  
Lauren Epstein ◽  
Lisa E. Davidson ◽  
Shira Doron
Keyword(s):  
Incidence Rate ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Acute Care Hospital ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Hospital Acquired

OBJECTIVETo offer antimicrobial stewardship to a long-term acute care hospital using telemedicine.METHODSWe conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired Clostridium difficile infection (CDI) rates and antimicrobial use. Simple linear regression was used to analyze changes in antimicrobial use; Poisson regression was used to estimate the incidence rate ratio in CDI rates. The preimplementation period was April 1, 2010–March 31, 2011; the postimplementation period was April 1, 2011–March 31, 2014.RESULTSDuring the preimplementation period, total antimicrobial usage was 266 defined daily doses (DDD)/1,000 patient-days (PD); it rose 4.54 (95% CI, −0.19 to 9.28) per month then significantly decreased from preimplementation to postimplementation (−6.58 DDD/1,000 PD [95% CI, −11.48 to −1.67]; P=.01). The same trend was observed for antibiotics against methicillin-resistant Staphylococcus aureus (−2.97 DDD/1,000 PD per month [95% CI, −5.65 to −0.30]; P=.03). There was a decrease in usage of anti-CDI antibiotics by 50.4 DDD/1,000 PD per month (95% CI, −71.4 to −29.2; P<.001) at program implementation that was maintained afterwards. Anti-Pseudomonas antibiotics increased after implementation (30.6 DDD/1,000 PD per month [95% CI, 4.9–56.3]; P=.02) but with ongoing education this trend reversed. Intervention was associated with a decrease in hospital-acquired CDI (incidence rate ratio, 0.57 [95% CI, 0.35–0.92]; P=.02).CONCLUSIONAntimicrobial stewardship using an electronic medical record via remote access led to a significant decrease in antibacterial usage and a decrease in CDI rates.Infect. Control Hosp. Epidemiol. 2016;37(4):433–439

Implementation of an Antimicrobial Stewardship Program at a 60-Bed Long-Term Acute Care Hospital

2012 ◽  
Vol 33 (4) ◽  
pp. 405-408 ◽  
Author(s):  
Perry G. Pate ◽  
Donald F. Storey ◽  
Donna L. Baum
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Antimicrobial Stewardship Program ◽  
Chart Audit ◽  
Stewardship Program

We implemented an antimicrobial stewardship program at an urban, 60-bed long-term acute care hospital using a strategy of weekly postprescriptive chart audit with intervention and feedback. The results for the first 15 months demonstrated 80% acceptance of recommendations, a 21% reduction in use, and a 28% reduction in cost per patient-day.

scholarly journals Investigation of a Group A Streptococcal Outbreak Among Residents of a Long-term Acute Care Hospital

2011 ◽  
Vol 52 (8) ◽  
pp. 988-994 ◽  
Author(s):  
M. Deutscher ◽  
S. Schillie ◽  
C. Gould ◽  
J. Baumbach ◽  
M. Mueller ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Group A

Chronic Comorbid Illnesses Predict the Clinical Course of 866 Patients Requiring Prolonged Mechanical Ventilation in a Long-Term, Acute-Care Hospital

2018 ◽  
Vol 35 (8) ◽  
pp. 745-754 ◽  
Author(s):  
J. Dermot Frengley ◽  
Giorgio R. Sansone ◽  
Robert J. Kaner
Keyword(s):  
Mechanical Ventilation ◽  
Acute Care ◽  
Clinical Course ◽  
Prolonged Mechanical Ventilation ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Term Survival ◽  
Group A ◽  
Chronically Critically Ill

Objective: To determine whether burdens of chronic comorbid illnesses can predict the clinical course of prolonged mechanical ventilation (PMV)patients in a long-term, acute-care hospital (LTACH). Methods: Retrospective study of 866 consecutive PMV patients whose burdens of chronic comorbid illnesses were quantified using the Cumulative Illness Rating Scale (CIRS). Based on increasing CIRS scores, 6 groups were formed and compared: group A (≤25; n = 97), group B (26-28; n = 105), group C (29-31; n = 181), group D (32-34; n = 208), group E (35-37; n = 173), and group F (>37; n = 102). Results: As CIRS scores increased from group A to group F, rates of weaning success, home discharges, and LTACH survival declined progressively from 74% to 17%, 48% to 0%, and 79% to 21%, respectively (all P < .001). Negative correlations between the mean score of each CIRS group and correspondent outcomes also supported patients’ group allocation and an accurate prediction of their clinical course (all P < .01). Long-term survival progressively declined from a median survival time of 38.9 months in group A to 3.2 months in group F ( P < .001). Compared to group A, risk of death was 75% greater in group F ( P = .03). Noteworthy, PMV patients with CIRS score <25 showed greater ability to recover and a low likelihood of becoming chronically critically ill. Diagnostic accuracy of CIRS to predict likelihood of weaning success, home discharges, both LTACH and long-term survival was good (area under the curves ≥0.71; all P <.001). Conclusions: The burden of chronic comorbid illnesses was a strong prognostic indicator of the clinical course of PMV patients. Patients with lower CIRS values showed greater ability to recover and were less likely to become chronically critically ill. Thus, CIRS can be used to help guide clinicians caring for PMV patients in transfer decisions to and from postacute care setting.

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