title: An Automated, Pharmacist-Driven Initiative Improves Quality of Care for Staphylococcus aureus Bacteremia.
abstract: BACKGROUND
  Infectious diseases (ID) consultation and antimicrobial stewardship intervention have been shown to improve the management of Staphylococcus aureus bacteremia (SAB). As the workload of antimicrobial stewardship programs (ASPs) continues to increase, ASPs must find a way to maximize the efficiency of the program while optimizing patient outcomes. The objective of this study was to evaluate the impact of incorporating health informatics into the management of SAB via a pharmacist-driven initiative.
  
  
  METHODS
  Retrospective, single-center quasi-experimental study of hospitalized patients with SAB. During the intervention period, pharmacists were alerted to patients with SAB via a patient scoring tool integrated into the electronic medical record. Pharmacists utilized the scoring tool and the institution's evidence-based practice guideline to make standardized recommendations to promote adherence to SAB quality-of-care measures and encourage ID consultation. The primary outcome was overall compliance along with adherence to individual quality-of-care components. Secondary clinical outcomes were also analyzed.
  
  
  RESULTS
  In sum, 84 patients were identified for study inclusion, 45 in the pre-intervention and 39 in the intervention group. As a whole, all 4 quality-of-care components for the management of SAB were significantly more frequently adhered to in the intervention group (68.9% vs 92.3%; P = .008). The incidence of ID consult improved significantly by almost 20% in the intervention group (75.6% vs 94.9%, P = .015). No statistically significant differences in duration of bacteremia, length-of-stay, infection-related length-of-stay, or readmission were observed between the groups. The incidence of all-cause mortality was 6-fold higher in the pre- intervention group compared to the intervention group (15.6% vs 2.6%, P = .063).
  
  
  CONCLUSIONS
  An automated, pharmacist-driven intervention for the management of patients with SAB demonstrated a significant improvement in patients receiving an ID consult, targeted antimicrobial therapy, and adherence to all SAB quality-of-care measures. As antimicrobial stewardship becomes a mandatory aspect of healthcare in all hospitals in the United States, ASPs will be forced to find ways to provide more efficient, impactful, disease state-based patient care. Our study provides the framework for and data to support this intervention in one of the most clinically important infectious diseases.
authors.affiliation: College of Pharmacy, University of Illinois at Chicago.
authors.forename: Eric
authors.initials: E
authors.lastname: Wenzler
authors.affiliation: Pharmacy.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.affiliation: Pharmacy.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goff
authors.affiliation: Pharmacy.
authors.forename: Beth
authors.initials: B
authors.lastname: Prier
authors.affiliation: Pharmacy.
authors.forename: John
authors.initials: J
authors.lastname: Mellett
authors.affiliation: Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Mangino
authors.affiliation: Pharmacy.
authors.forename: Karri A
authors.initials: KA
authors.lastname: Bauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000073602:Antimicrobial Stewardship; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D019468:Disease Management; D057286:Electronic Health Records; D019317:Evidence-Based Medicine; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010607:Pharmacy Service, Hospital; D017064:Process Assessment, Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Staphylococcus aureus; bacteremia; pharmacist; process measure; quality of care