At a Rural Veterans Affairs Medical Center, Telehealth Decreased Antibiotic Use in Long-Term, but not Acute Care

Abstract

BackgroundHealthcare facilities without access to infectious diseases (ID) expertise may struggle to implement effective antibiotic stewardship programs. In August 2016, we launched a pilot project using the Veterans Affairs (VA) telehealth system to form a Videoconference Antimicrobial Stewardship Team (VAST) to connect a multidisciplinary team from a rural VA medical center with ID physicians at a remote site to support antibiotic stewardship. Here, we present preliminary outcomes summarizing antibiotic use at a rural VA medical center with 27 acute and 162 long-term care beds before and after the VAST implementation.MethodsWeekly VAST meetings began in August 2016. Using VHA databases, we determined the agent days (number of days a patient received a particular agent), the antibiotic days (the number of days a patient received any antibiotic) and length of therapy. We compared the rates of agent days and antibiotics days per 1000 bed days of care (BDOC) in the pre- implementation (January 2016–July 2016) and post- implementation periods (September 2016–March 2017) for acute and long-term care units.ResultsIn acute care, agent days, antibiotic days and length of therapy did not change notably after VAST implementation (table). For long-term care, agent days decreased by 45%, antibiotic days by 42% and length of therapy by 37%. Also, the ratio of agent days to antibiotic days reveals that in acute care patients received on average 1.5 antibiotics (pre- and during the VAST) compared with 1.2 (pre-VAST) and 1.1 (during the VAST) in long-term care. Acute Care Long-Term Care Outcomes Measures Pre-VASTVASTReductionPre-VASTVASTReductionAgent Days/1000 BDOC100899612 (1%)623428 (45%)Antibiotic Days/1000 BDOC6536449 (1%)523022 (42%)Mean Length of Therapy (days)4.574.460.12 (3%)8.935.603.33 (37%)Conclusion Weekly multidisciplinary VAST meetings led to decreased rates of antibiotic use and length of therapy in the long-term but not acute care units of a rural VA medical center. Reasons for these differences may relate to the long-term care setting, which is an environment that permits active monitoring off antibiotics. Other possible reasons include differences in patient acuity and provider practice patterns.Disclosures All authors: No reported disclosures.