Antibiotics are certainly powerful in fighting infections. But now hospital organizations are finding that they need to battle the impact of antibiotics, too, stemming from patient and prescribing overuse. For hospital leaders, innovative IT systems are becoming critically important to accomplish that task.
Overprescribing antimicrobials have led to antibiotic resistance. At least 700,000 people die each year from antibiotic resistant infections, and that number may reach 10 million each year by 2050.
Something called antimicrobial stewardship – a way in which hospitals keep an eye on such prescribing – is what some health systems are trying to do to cut down on antimicrobial infections. That means ordering, dispensing, administering and monitoring antimicrobial stewardship practices. It also means working with patients, educating them about the appropriate use of medications.
IT technology is a key element in helping physicians access timely clinical information about antibiotics at the point of care. In that way, they can figure out the antimicrobial puzzle. While many hospitals are improving their IT system to carry out the task, not enough are using antimicrobial stewardship programs so they can reach their potential in helping patients.
“Many stewardship programs in hospitals today only provide feedback on antibiotic prescriptions, one or more days after the patient has already been started on an antibiotic,” says Brandon Palermo, MD, MPH, executive director and chief medical officer, for ILÚM Health Solutions in HIStalk. “But it’s important to use technology to engage and guide clinicians in real time from the beginning with an antibiotic ordered and to continue tracking pathway adherence as additional microbiology data becomes available and it’s important to be able to support this within their existing workflows.”
ILÚM Health Solutions says it provides an array of tools and services that help hospitals and health systems improve outcomes for conditions like sepsis and pneumonia while implementing key components of their antimicrobial stewardship initiatives. The company offers a technology-powered program that helps hospitals improve their infection disease outcome and supports antimicrobial stewardship programs. It is part of Merck’s Healthcare Services and Solutions group and operates independently from Merck’s pharmaceutical products business.
The ILÚM system works by leveraging data within existing hospital IT systems to promote “optimal decision-making and appropriate use of antimicrobials” through its clinical decision support (CDS) system and Command Center, an electronic dashboard, according to the company. These solutions “enable case monitoring and prioritization – on an individual and aggregate level based on disease state – and promote early recognition of infectious diseases, appropriate interventions, and adherence to evidence-based clinical pathways,” the company says.
Technology needs to effectively connect everyone on the stewardship team – doctors, nurses, quality managers, pharmacists and healthcare executives, Palermo says. In addition, he says hospitals and clinicians need help accessing important data that are often buried within complex systems.
Hospitals are now required to establish antimicrobial stewardship programs as an organizational priority, under a Joint Commission requirement that became effective Jan. 1, 2017, Palermo says. Palermo wrote in Becker’s Hospital Review that antibiotic stewardship programs can save hospitals a bundle, too. He referred to a University of Maryland study that showed one institution saved $17 million in seven years by implementing such a program.
“Technology needs to give us antibiotic foresight, not just hindsight,” he says in HIStalk. “A root cause of antibiotic resistance is the systemic overuse and inappropriate use of antibiotics. While many factors account for this, a key issue is the lack of timely clinical information at the point of care.”
The Battle Against Sepsis
One hospital that has worked feverishly on this issue is East Jefferson General Hospital, 424-bed general medical and surgical hospital in Metairie, La., which reported a pilot study last December at the Institute of Health Improvement’s Quality Forum Institute of Health Improvement’s Quality Forum. East Jefferson General Hospital partnered with ILÚM as part of a hospital-wide initiative targeting sepsis quality improvement, which included “multi-disciplinary departmental collaboration and sponsorship from administration and medical leadership,” said Raymond DeCorte, chief medical officer for EJGH.
“This innovative solution has helped us to identify patients with sepsis faster, care for them better and reduce the use of critical hospital resources,” he says. Antibiotic resistant bacteria are often the root cause of infections that trigger sepsis, according to the Mayo Clinic.
Sepsis is a potentially life-threatening complication of an infection, resulting in 750,000 deaths in the U.S. every year and is a major cost driver of health systems. Studies show that hospitals spend an average of $34,000 for each patient with sepsis.
The clinical decision support system helped physicians improve sepsis recognition and adherence to evidence-based care, leading to significantly improved outcomes and reduced resource utilization.
Among patients with all sepsis types, a reduction in hospital length of stay – 7.11 to 6.81 days -was observed. Among patients with severe sepsis, significantly fewer patients developed hospital-onset shock in the study group compared to the control group, 19 percent vs. 35 percent. All cause mortality rates decreased from 23.2 percent to 7.9 percent.
Palermo says automated outcomes reporting is configured to hospital-specific initiatives that track quality program performance.
“We know that following evidence-based pathways for sepsis can save lives, but it’s not that simple,” he told HIStalk. “These pathways call for interventions where time is critical, and early recognition of sepsis is a challenge that continues to vex health systems. I can tell you from my own experience as a practicing physician that this can be a huge hurdle.
“Our collaborations with partner hospitals launch with two parallel tracks – benchmarking and integration,” Palermo added in the interview with HIStalk. “We assist with benchmarking to establish baselines and identify target areas for quality improvement. Our plan is to build out disease modules for various types of infections using a value and data driven approach. We plan to expand to hospitals and health systems across the country and continue to bring key industry players together.”
IT helps us to determine appropriate use of antimicrobials and to execute against stewardship priorities by analyzing and reporting data that reinforce the impact of the program, wrote Debra A. Goff, PharmD, FCCP, a clinical associate professor and infectious diseases specialist at the Ohio State University Wexner Medical Center.
“It can also help prioritize patients in real time by providing actionable intelligence,” Goff adds. “You can also drill down to look at individual prescribing habits, individual drugs and who may be driving those prescriptions within the hospital.” — Joe Cantlupe