Metrics are becoming increasingly important in healthcare. Regulators want to see how hospitals perform across a large number of quality and safety measures. Insurers look for evidence of adherence to best practices for care and cost-effective treatment. Patients want to see how hospitals compare in terms of safety, costs and patient satisfaction.
Advocates for antimicrobial stewardship programs (ASPs) who understand the metrics that are high priority for their hospital can tie their programs to these key measures and increase funding for program enhancement or implementation.1 While an effective ASP can improve many measures, advocates may want to focus on three high-profile metrics:
1. Reduced pharmacy costs: Up to 50% of antibiotics prescribed in U.S.hospitals are unnecessary or inappropriate. By improving prescribing practices, antimicrobial stewardship programs reduce the use of antimicrobials overall, and the use of broad-spectrum antimicrobials, in particular. Three strategies can quickly produce pharmacy savings:
Automatic stops for empiric therapy after 48 hours. Stopping antimicrobials in the absence of laboratory confirmed infection ensures that only patients who need antimicrobials receive them and that those patients receive a drug well matched to the “bug” they have.
Conversion of intravenous medications to oral equivalents as quickly as possible. Oral medications tend to be less expensive and reduce the time patients stay in the hospital.
Shortened courses of surgical prophylaxis. The American Society of Health-System Pharmacists (ASHP) advises that antimicrobial prophylaxis for surgery should be less than 24 hours for most procedures.2
2. Reduced rates of Clostridium difficile infections. A serious and growing public health problem, increased C. diff. rates are associated with inappropriate antimicrobial use.3 Many hospitals see lower rates once they implement antimicrobial stewardship programs. C. diff. rates must also be reported to the National Healthcare Safety Network, so this metric already has the attention of hospital administrators.
3. Shorter lengths of stay. Antimicrobial stewardship programs improve patient safety and the quality of care by implementing steps to ensure better bug-drug matches. As a result, patients experience fewer treatment failures, reduced complications and shorter stays in the hospital. Those shorter stays are associated with reduced direct costs for the hospital and lower rates of non-reimbursed costs for healthcare-associated infections.
Whether you use these measures or others, making a clear connection between the antimicrobial stewardship program and metrics that matter to your hospital’s administration provide the best path to increased funding and greater overall support for your program.
1. Morris, A. The Business of Antimicrobial Stewardship. PowerPoint. Antimicrobial Stewardship Program, Mt. Sinai Hospital/University Health Network.
2. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. ASHP Report, Am J Health-Syst Pharm. 2013; 20:195-283.
3. The Evaluation and Research on Antimicrobial Stewardship’s Effect on Clostridium difficile (RASE C. difficile) Project. Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cdifftoolkit/index.html