Hospitalists are at the center of many proposed interventions to improve antimicrobial prescribing practices, half of which are estimated to be unnecessary or inappropriate, with serious cost and safety consequences, says Scott Flanders, MD, FACP, SFHM, professor of medicine and director of the hospitalist program at the University of Michigan Health System in Ann Arbor.
Dr. Flanders, past president of SHM, is on the faculty of a new Institute for Healthcare Improvement (IHI) initiative kicked off in Boston in late October to test the feasibility of those interventions in hospitals of varying models.
The CDC's national campaign Get Smart for Healthcare recommends formal antimicrobial stewardship programs in hospitals to ensure that patients routinely receive the right antibiotic in the right dose at the right time for the right duration. The CDC website cites a number of studies showing the positive effects of such stewardship on antimicrobial use, antimicrobial resistance, the incidence of Clostridium difficile infections, cost, and other endpoints.
The CDC has engaged IHI to define and pilot-test the feasibility of expert-recommended interventions and approaches at eight hospitals through June 2012. The testing could lead to modifications in approaches, perhaps a second round of testing, and an IHI collaborative, says Diane Jacobsen, IHI project manager.
Eventually, Dr. Flanders adds, SHM might offer its own toolkit of resources for hospitals and hospitalists, and mentored implementation along the lines of its other major quality initiatives.
"The biggest thing for hospitalists is awareness of the problem, and then a commitment to appropriate, evidence-based selection and de-escalation of antibiotics," Jacobsen adds.