Increasing Local Productivity Through a Regional Antimicrobial Stewardship Collaborative
Background: Antimicrobial stewardship programs (ASPs) are vital to improving patient safety and ensuring quality of care but are often underresourced, limiting their effectiveness and reach. While barriers to ASP success have been well documented, approaches to address these barriers with limited resources are needed. Stewardship networks and collaboratives have emerged as possible solutions. In January 2020, 5 US Department of Veterans Affairs facilities created a regional ASP collaborative. In this article, we describe the impact of this collaborative on the productivity of the facilities’ ASPs.
Methods: ASP annual reports for each of the 5 facilities provided retrospective data. Reports from fiscal year (FY) 2019 and reports from FY 2020-2022 were reviewed. Staffing, inpatient and outpatient stewardship reporting, individual and collaborative initiatives, and publications data were collected to measure productivity. Yearly results were trended for each facility and for the region. Additionally, the COVID-19 antibiotic use dashboard and upper respiratory infection dashboard were used to review the impact of initiatives on antibiotic prescribing during the collaborative.
Results: Regular reporting of outpatient metrics increased; 27% of measures showed improvement in 2019 and increased to 60% in 2022. For all 5 facilities, ASP initiatives increased from 33 in 2019 to 41 in 2022 (24% increase) with a corresponding increase in collaborative initiatives from 0 to 6. Likewise, publications increased from 2 in 2019 to 17 in 2022 (750% increase). Rates of reporting and improvement in inpatient metrics did not change significantly.
Conclusions: The ASP collaborative aided in efficiency and productivity within the region by sharing improvement practices, distributing workload for initiatives, and increasing publications.
The importance of formalized antimicrobial stewardship programs (ASPs) has gained recognition over the past 2 decades. The increasing requirements for ASP programs from national entities often outpace the staffing, technology, and analytic support needed to meet these demands.1,2 A multimodal approach to stewardship that includes education initiatives, audit-and-feedback methodology, and system support is effective in producing sustained change.3 However, this approach is resource intensive, and many ASPs must look outward for additional support.
Centralized ASP collaboratives and stewardship networks have been effective in positively impacting initiatives and outcomes through resource sharing.3-5 These collaboratives can take on multiple forms ranging from centralized education distribution to individual sites coming together to set goals and develop strategies to address common issues.5-8 Collaboratives can provide enhanced data analysis through data pooling, which may lead to shared dashboards or antibiotic use (AU) reports, allowing for robust benchmarking.5-7 Productivity at individual centers is often measured by AU and antimicrobial resistance (AMR) rates, but these measures alone do not fully capture the benefits of collaborative participation.
The US Department of Veterans Affairs (VA), similar to other large health care systems, is uniquely positioned to promote the development of ASP collaboratives due to the use of the same electronic health record system and infrastructure for data. This centralized data lends itself more readily to data dashboards and interfacility comparison. In turn, the identification of facilities that have outlying data for specific measures can lead to a collaborative effort to identify aberrant processes or facility-specific problems and identify, implement, and track the progress of appropriate solutions with less effort and resources.7 The VA has a national stewardship group, the Antimicrobial Stewardship Task Force (ASTF), that identifies and disseminates best practices and advocates for stewardship resources.
VA facilities are heterogeneous with regard to patient population, services, availability of specialists, and antibiotic resistance patterns.9 Therefore, clinical practice and needs vary. The ASTF has spearheaded the development of regional collaboratives, recognizing the potential benefit of smaller groups with shared leadership.The Veterans Integrated Services Networks (VISNs) are geographically demarcated regions that lend themselves well to coordination among member facilities due to similar populations, challenges, and opportunities. The Veterans Affairs Midsouth Healthcare Network (VISN 9) includes 5 facilities across Tennessee, Kentucky, Mississippi, Arkansas, Georgia, Virginia, and Indiana and serves about 293,000 veterans, ranging from 35,000 to 105,000 per facility.
A VISN 9 stewardship collaborative (as described by Buckel and colleagues in 2022) was established to enhance member facility ASPs through shared goal setting.6 Initially, the collaborative met quarterly; however, with increased participation and the onset of COVID-19, the collaborative evolved to meet burgeoning ASP needs. While intrafacility multidisciplinary ASP collaboration has been previously published, few publications on interfacility collaborations exist.3-6 To our knowledge, no previous publications have reported the impact of a VA ASP collaborative on the productivity and effectiveness of participating ASP facilities and the region. We aim to share the structure and processes of this ASP collaborative, demonstrate its impact through quantification of productivity, and aid others in developing similar collaboratives to further ASPs’ impact.
