Antibiotic Stewardship, Calgary 1995‐1997: Regionalization, Restructuring and Retrenchment

Abstract

Hospitals in the Calgary area have undergone a decade of change as a result of provincial and local initiatives to provide the same or better health care with fewer dollars. The new system includes 1850 beds at four hospitals, a continuing care sector coordinating nursing home and ambulatory care services, and population health and public health services. The reorganization is patient-ocused, using a “hospital without walls” concept to promote linkages and efficiencies in health care delivery. Before the elimination of individual hospital boards and the creation of one regional health board in 1994, each of the hospital groups had organized antibiotic utilization programs with the primary aims of making better use of antibiotics and taking efforts towards cost containment. Programs were more intensive and comprehensive at the teaching institutions. Community hospitals that adopted policies according to local needs. Being the primary teaching hospital in Calgary region, the Foothills Hospital practised a series of antimicrobial use and restriction guidelines via the Online Survey and Certification Reporting (OSCAR) hospital computer system. At the Calgary General and Alberta Children’s hospitals, the infectious diseases consultation service was used to restrict the excessive use of broad-spectrum and expensive antimicrobial agents. Four of the five hospitals had antibiotic utilization subcommittees that reported to pharmacy and therapeutics committees. Three part-time drug use evaluation (DUE) pharmacists (0.25 to 0.6 full-time equivalent) were available to monitor antimicrobial use and fulfill an educational function. Specific antibiotic stewardship activities included writing pharmacy newsletters, monitoring intravenous to oral stepdown, tracking antimicrobial costs, instituting therapeutic interchanges, standardizing antibiotic regimens, and reviewing cephalosporin, vancomycin, clindamycin and imipenem/cilastatin use. Individual cost cards indicating antimicrobial susceptibilities were updated annually by each hospital group. Plans for downsizing and reorganizing hospital services were made between 1991 and 1994. Three of seven hospitals were closed between 1995 and 1997. A $100 million renovation and building program was implemented and completed to upgrade remaining facilities. The hospital and community laboratory systems have been merged into a public/private service company, and all microbiology services have been consolidated into one central ‘core’ laboratory. While disadvantages may be associated with not having a microbiology laboratory in each of the hospitals, the centralized laboratory can provide important advantages withregard to tracking and monitoring antibiotic resistance. Further examples of the restructuring of hospital services include the consolidation of all pharmacies under one regional administration, and the reorganization of the individual antibiotic utilization subcommittees into one regional, antibiotic utilization, working group. Although the majority of antibiotic use policies have been retained during hospital consolidation, standardization is now taking place. The DUE pharmacist po-