title: Impact of an antimicrobial stewardship programme on patient safety in Singapore General Hospital.
abstract: Whilst studies have shown that antimicrobial stewardship programmes (ASPs) can effectively reduce antibiotic utilisation, cost of care and even antimicrobial resistance rates, ASPs should avoid the perception that the goal is primarily to reduce antibiotic purchases and costs, instead of focusing on improving the quality of care. In addition, to address the concern of primary physicians who deemed that ASPs' choices of antibiotics were often inadequate, the impact of ASPs on patient safety should be monitored and evaluated. The aim of this study was to analyse the impact of ASP interventions on patient safety in Singapore General Hospital (SGH), a 1559-bed, large, acute, tertiary-care hospital in Singapore. A retrospective database review of data on ASP interventions issued between October 2008 and September 2010 was performed. The database maintained by the ASP team detailed patients' demographic data as well as outcomes of issued interventions. The ASP recommended 1256 interventions in a total of 1249 admissions in six departments. Shorter average length of stay (mean ± standard deviation 19.4 ± 19.9 days vs. 24.2 ± 24.2 days) was observed among patients of physicians who accepted ASP suggestions compared with patients of physicians who rejected ASP interventions (P<0.01). ASP interventions did not alter all-cause mortality (P=0.191). In addition, the number of infection-related re-admissions (P<0.001) and the 14-day re-infection rate (P=0.009) were higher among patients whose physicians rejected ASP interventions. In conclusion, interventions recommended by the ASP in SGH were safe and were associated with a reduction in the duration of hospital stay, 14-day re-infection rate and infection-related re-admissions.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. liew.yi.xin@sgh.com.sg
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Liew
authors.forename: Winnie
authors.initials: W
authors.lastname: Lee
authors.forename: Joan Chain Zhu
authors.initials: JC
authors.lastname: Loh
authors.forename: Yiying
authors.initials: Y
authors.lastname: Cai
authors.forename: Sarah Si Lin
authors.initials: SS
authors.lastname: Tang
authors.forename: Cheryl Li Ling
authors.initials: CL
authors.lastname: Lim
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Teo
authors.forename: Rachel Wen Qin
authors.initials: RW
authors.lastname: Ong
authors.forename: Andrea Lay-Hoon
authors.initials: AL
authors.lastname: Kwa
authors.forename: Maciej Piotr
authors.initials: MP
authors.lastname: Chlebicki
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000401:mortality; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061214:Patient Safety / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000592:standards*; D012189:Retrospective Studies; D012846:Singapore; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents