title: Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborative.
abstract: Inappropriate antimicrobial use in hospitalized patients contributes to antimicrobial-resistant infections and complications. We sought to evaluate the impact, barriers, and facilitators of antimicrobial stewardship best practices in a diverse group of hospital medicine programs. This multihospital initiative included 1 community nonteaching hospital, 2 community teaching hospitals, and 2 academic medical centers participating in a collaborative with the Centers for Disease Control and Prevention and the Institute for Healthcare Improvement. We conducted multimodal physician education on best practices for antimicrobial use including: (1) enhanced antimicrobial documentation, (2) improved quality and accessibility of local clinical guidelines, and (3) a 72-hour antimicrobial "timeout." Implementation barriers included variability in physician practice styles, lack of awareness of stewardship importance, and overly broad interventions. Facilitators included engaging hospitalists, collecting real time data and providing performance feedback, and appropriately limiting the scope of interventions. In 2 hospitals, complete antimicrobial documentation in sampled medical records improved significantly (4% to 51% and 8% to 65%, P < 0.001 for each comparison). A total of 726 antimicrobial timeouts occurred at 4 hospitals, and 30% resulted in optimization or discontinuation of antimicrobials. With careful attention to key barriers and facilitators, hospitalists can successfully implement effective antimicrobial stewardship practices. Journal of Hospital Medicine 2016;11:576-580. © 2016 Society of Hospital Medicine.
authors.affiliation: Department of Internal Medicine, University of Michigan Hospital and Health System, Ann Arbor, Michigan.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Mack
authors.affiliation: Department of Internal Medicine, University of Michigan Hospital and Health System, Ann Arbor, Michigan.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rohde
authors.affiliation: Institute for Healthcare Improvement, Cambridge, Massachusetts.
authors.forename: Diane
authors.initials: D
authors.lastname: Jacobsen
authors.affiliation: Department of Internal Medicine, Spectrum Health System, Grand Rapids, Michigan.
authors.forename: James R
authors.initials: JR
authors.lastname: Barron
authors.affiliation: Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Christin
authors.initials: C
authors.lastname: Ko
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: Goonewardene
authors.affiliation: Department of Internal Medicine, Hofstra North Shore LIJ School of Medicine, Manhasset, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Rosenberg
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: Department of Internal Medicine, University of Michigan Hospital and Health System, Ann Arbor, Michigan.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
mesh_terms: D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D003299:Cooperative Behavior; D004282:Documentation; D064416:Hospital Medicine; D020445:Hospitalists / Q000193:education / Q000458:organization & administration / Q000592:standards*; D006764:Hospitals, Community; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D017410:Practice Guidelines as Topic / Q000592:standards*; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents