Pneumonia is the fourth most common cause of hospital admissions in the United States and the eighth most expensive condition, accounting for over $9.5 billion annually in inpatient costs alone. Multiple clinical trials have shown that shorter durations of antibiotic treatment (5 to 7 days) are as safe and effective as longer courses, findings which are now reflected in recent updates to professional society guidelines. Increasing adherence to these guidelines would decrease average length of stay, costs, antibiotic-related side effects and comorbidities, and the development of resistant organisms while still providing high-quality patient care.
Purpose:
To implement a house staff-led stewardship program and raise awareness regarding the prudent and appropriate use of antibiotics, specifically the recommended durations of treatment for adults with pneumonia admitted at a large academic medical center.
Description:
We conducted a retrospective chart review of a subset of patients admitted with pneumonia at our institution between March 2015 and September 2015 and found that community-acquired pneumonia was being treated for over 7 days and hospital/healthcare-related pneumonia for over 9 days on average. After synthesizing professional society guidelines and consulting with institutional infection control and infectious disease leadership, we generated publicity materials reflecting consensus choices for antibiotic regimens and durations of treatment.
Our interventions included email reminders to house staff, nurse practitioners and attendings; announcements about the initiative during team rounds and other educational sessions (e.g. weekly teaching rounds); an optional prompt in the electronic medical records system for use in daily progress notes; and the deployment of posters, handouts, and a hospital-wide screensaver slide. Our initiative aligned with the release of new Infectious Diseases Society of America guidelines that move towards eliminating healthcare-associated pneumonia (HCAP) as a distinct clinical entity, which provided a compelling teaching point for all members of the team.
We piloted our interventions with a subset of teaching teams from March to June 2016 and fully implemented the program in September 2016. Interim data are suggestive of downtrending average durations of treatment from the 2015 baseline (see table), but analyses are ongoing and further study is needed before we can draw definitive conclusions.
Conclusions:
A house staff-led pneumonia antibiotic stewardship program can raise awareness of updated treatment and disease classification guidelines among all members of the inpatient team. Further data collection and analyses are in progress to evaluate for a significant impact on length of stay and other outcomes.