P-982. Stewards working smarter not harder: Improving cross-disciplinary communication in bacteremia management

TL;DR

This paper describes a more efficient workflow for managing blood infections using electronic platforms to improve communication among healthcare professionals.

Contribution

A sustainable electronic platform was implemented to enhance cross-disciplinary communication in managing bacteremia.

Findings

The electronic platform increased engagement with over 40 monthly activities and 15 active users.

There was a 60% decrease in PCR approvals and a trend toward higher de-escalation acceptance.

Fewer deaths were observed 7 and 60 days after positive cultures, though not statistically significant.

Abstract

Antimicrobial Stewardship Programs (ASP) respond to real-time data and transmit critical information in patient-level and programmatic interventions across healthcare settings. Our ASP created a sustainable, more efficient workflow for positive blood cultures by leveraging existing electronic platforms to manage real-time data and coordinate clinical management.

Real-time alerts for positive blood cultures (TheraDoc, DSS Inc) were transferred to a shared secure electronic platform approved for interinstitutional patient-care 5/2022-12/2024 from inpatient, outpatient, long-term care and dialysis units at the Washington DC VA Medical Center. ID Physicians, ID Fellows, Pharmacists and Microbiologists participated in this quality improvement initiative. A PCR array for blood (BioFire, Inc) was introduced onto existing organism identification technology (Sepsityper and MALDI, Bruker Inc) when rapid detection of MDR genes in E. coli, K. pneumoniae, S. aureus, E. faecalis might change management. lab posted real-time updates; ASP reviewed therapy and prioritized referrals to ID for serious pathogens or any organism where intensive care required.

487 bacteremic episodes were posted from >1200 + cultures in 321 unique veterans; patients were largely male, older and 1 in 4 experienced >1 episode (98%, 72±13y). Over the period of observation, the continuously maintained secure thread averaged >40 engagement activities (post/reply/reaction) monthly with 15 active users. With preliminary and early results shared directly via thread, stewards advocated for ID consultation and guided therapy choice. By 2024 there was a 60% decrease in PCRs approved (P=0.009) and the acceptance of recommendation to de-escalate based on pre decisional PCR trended higher (30% ↑, P=0.45). Along with other ASP measures and more ID involvement, a trend over time was seen in fewer deaths 7 and 60 days from + culture (50%↓ and 15%↓, P=NS)

The electronic platform promoted active engagement between users and was a sustainable method of cross-disciplinary communication for critical laboratory information. The burden of duplicative efforts was reduced. Stewards prioritized time for consultation, therapy appropriateness, and had more time to communicate with non-ID staff.

All Authors: No reported disclosures