Society of Hospital Medicine Resources to Empower Hospitalist Antibiotic Stewardship EffortsPosted on by
Guest Author: Jennifer Townsend, MD,
Antimicrobial Stewardship Program at Johns Hopkins Medical Center,
ID Consultant to the Hospitalist Service
Hospitalists have assumed major roles in inpatient care in both academic and community settings. At many institutions, hospitalists manage the majority of patients who have infectious disease diagnoses.
High antibiotic use is endemic in hospitals. National efforts have been made to involve hospitalists in stewardship efforts, such as the “Antibiotic Stewardship Driver Diagram and Change Package” prepared by the Institute for Healthcare Improvement for CDC in 2011, and ongoing initiatives among hospitalist groups, including the University of Michigan and our hospitalist division at Johns Hopkins Bayview.
But sustaining change is challenging, especially in busy clinical services that are rapidly growing. Hospitalists are busy and turn over patients frequently. It takes dedication and mindfulness to engage in critical thinking and standard documentation around antibiotic choices. And small changes in systems can make a big difference in supporting a culture that emphasizes appropriate prescribing of antibiotics.
Hospitalists can play a key role in leading and implementing antibiotic stewardship efforts. To support them, and in coordination with the Society of Hospital of Medicine’s “Fight the Resistance Campaign,” we created a resource to give hospitalists some of the tools they need to take small but measurable steps toward implementing best practices in antimicrobial stewardship.
This month, the SHM launched our new hospitalist education tool, Project STEP In (Stewardship Through Education of Providers in the Inpatient Setting), which includes a comprehensive implementation guide to help hospitalist leaders assess the state of prescribing in their hospitals. Additionally, we developed 3 online educational modules with case studies that address common causes for antibiotic overuse in skin and soft tissue infections, respiratory infections and urinary tract infections. The modules emphasize 4 steps in optimal antibiotic use: 1) correct diagnosis, 2) risk stratification for resistant organisms, 3) targeted empiric therapy, and 4) de-escalation. The resource is designed to inform the development of a mentored implementation program or small scale improvement projects lead by hospitalists with the goal of creating a subset of “hospitalist stewards” who can serve as peer role models and change agents within their hospitals.
Through this educational program and others like it, we hope to empower hospitalists around the country to reduce overprescribing by becoming “mindful and judicious prescribers” of these valuable drugs and ultimately fight the resistance.
Jennifer Townsend, MD has served as the lead consultant on the CIMS ID Consult Service and Co-Director of the Antimicrobial Stewardship Program at Johns Hopkins Bayview Medical Center in Baltimore, MD since 2014.