Allegheny Health Network’s (AHN) Thomas Walsh, MD, talks about Allegheny General Hospital being recognized as an Infectious Diseases Society of America (IDSA) Center of Excellence and some of the stewardship strategies they are employing to reduce antimicrobial usage.
The IDSA Centers of Excellence (CoE) program began in 2018, and it “recognizes institutions that have created stewardship programs led by infectious diseases physicians and ID-trained pharmacists that are of the highest quality and have achieved standards aligned with evidence-based national guidelines.”1
Allegheny General Hospital, which is the flagship hospital within the Allegheny Health Network (AHN), has been recognized as an IDSA Center of Excellence. In an
Thomas Walsh, MD, is the medical director for AHN’s antimicrobial stewardship program and spoke of the job his team has done in executing and pulling the data.
“We have an outstanding team here,” Walsh said. “We have 3 fantastic infectious disease pharmacists at Allegheny General Hospital and 1 at West Penn hospital—along with 3 infectious disease physicians and infectious disease data analysts to help us with pulling all this data—which is critical to understanding where opportunities lie and we've expanded this across the network.”
Walsh believes there is a lot of unnecessary antibiotic usage, so he sees opportunities in many areas for stewardship including the number of days patients are on antibiotics and the types of treatments they are prescribing.
“For every one of our antibiotic stewardship initiatives that we put in place, we want to monitor the impact of this,” he said. “So for example, we're monitoring every patient with a skin and soft tissue infection in the hospital that comes in. We want to get a lay of the land first, so we will see how we're doing with regard to our antibiotic use for those patients that come in with cellulitis. And if we see that we're utilizing too long of a course—which at AHN we were. We should be using 5 to 7 days—we were giving 14 days on average—and we should be using very narrow spectrum drugs.”
Additionally, Walsh says they are looking at strep and staph infections. He says they utilize a few strategies for stewardship programs.
“We put a lot of initiatives in place including, educational pieces, nudges within our electronic health record, and we audit the patients as well," Walsh said. "We talk to the teams every time a patient is admitted with one of those diseases to make sure we're on the right course of treatment and we're utilizing the right drug for the right duration. And then we monitor the impact of those interventions.”
In terms of results, they have seen a significant benefit. “We reduced our broad spectrum use by over 75% and patients actually had a shorter length of stay," Walsh said. "And we said, 'Okay, well, that's great. You're giving them less antibiotics, you're getting them out the door quicker. Are they having better outcomes?' Yeah, they were actually getting readmitted at lower rates too, by utilizing those more narrow spectrum, appropriate agents for the right duration.”
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