The overuse of antibiotics can lead to antibiotic resistance — a phenomena that kills an estimated 23,000 Americans with infections each year and contributes to $2.2 billion in costs to the U.S. healthcare system annually, according to 2018 Health Affairs study.
Although physicians often rely on past experience and available patient health data to make a clinically-educated decision for initial antimicrobial therapy, 30 to 60 percent of antibiotics prescribed in the ICU are unnecessary, inappropriate or suboptimal, according to a 2014 study led by Dr. Charles-Edouard Luyt and published in Critical Care Medicine.
Coupling the right data with the right rapid diagnostic tools, hospitals and providers can streamline the process for appropriate treatment identification, which can reduce the lead time to the most appropriate treatment and thereby lead to shorten length of stay. Ultimately, these improvements can lead to reduced 30-day readmission rates, according to TeleMed2U CMO Javeed Siddiqui, MD, MPH.
In a May 15 webinar sponsored by Accelerate Diagnostics and hosted by Becker's Hospital Review, Dr. Siddiqui explained how technology can integrate better decision support and improve quality outcomes, starting with the most critical area of the hospital: the intensive care unit [ICU].
Antibiotic stewardship should start in the ICU
ICU practices may vary between hospitals, but the underlying philosophy remains the same no matter what: "The essence of healthcare is getting the right information to the right provider so they can make the right interventions," Dr. Siddiqui said. He noted that for every hour delay in targeted antibiotic therapy, there is a 7.6 percent increase in mortality — according to a 2006 study published in Critical Care Medicine.
To deliver the best treatment as quickly as possible, the efficient delivery of actionable data is a must. EMRs may not be user-friendly, but they lay the foundation for real-time, structured clinical data capture. Combining real-time data with rapid diagnostics may help physicians complete real-time antibiograms, which would allow physicians to see the antimicrobial susceptibility of patient infections during treatment to identify resistance and select the most effective therapies.
Getting physicians to act without adding another EMR alert
Ensuring physicians see and act upon real-time EMR data, though, is its own challenge.
"Part of the problem is ... we put up pop up windows on the EMR and we [created] alerts that caused everyone to be desensitized … I get 100 alerts a day," Dr. Siddiqui said, adding that the industry needs to do a better job of making EMR data actionable without contributing to clinician alert fatigue.
Instead of creating another EMR alert, data should be tethered to a decision support system so treatment is proactive and forecasted, rather than reactive. The decision support solution can analyze EMR data to identify patients at-risk for developing complications down the road so that decisions can be made and communicated faster.
This type of analytics isn't new. However, implementing these solutions into clinician workflow in a way that makes sense, improves clinical efficiency and supports patient outcomes has proven difficult. , Dr. Siddiqui said. "It really is about taking all of that work, all of that information, over the last decade and making sure it is getting to the right people so they can make the right intervention and make the correct change."
3 steps for tech-driven quality improvement
Hospital ICUs can leverage technology that reduces the time it takes to deliver a confirmed, optimal therapy. According to Dr. Siddiqui, Accelerate Diagnostics' Pheno System can identify optimal treatments nearly 40 hours faster than other diagnostic tests. Augusta, Ga.-based University Hospital implemented the Accelerate test system in May 2017 and has since seen a 36 percent decline in mortality of patients with confirmed bacteremia as a percentage of overall in-patient mortality.
When used correctly, technology like Accelerate Diagnostics' solution can drive efficiencies and save lives. Dr. Siddiqui laid out three considerations for hospitals aiming to improve how they deploy and use technology:
1. Advanced use of telemedicine enhances intervention. Using telemedicine to connect medical specialists to patients across the care continuum is an easy way to improve acute interventions and deliver the best care possible.
2. Couple rapid diagnostics with integrated antibiotic stewardship. Delivering fast results can improve quality metrics such as patient outcomes, length of stay and 30-day readmissions. Integrating robust antibiotic stewardship with state-of-the-art diagnostics can decrease the time to administering optimal therapies and lower mortality.
3. Integrating EMR data creates a standardized approach to therapy interventions. Clinical intelligence can be applied to improve processes and track intervention impacts.
Click here to access the webinar recording.
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