Specialist trainees on rotation cannot replace dedicated consultant clinicians for antimicrobial stewardship of specialty disciplines

Chay Leng Yeo,Dale Fisher,Gladys Wei-Teng Chung,Li Yang Hsu,Douglas Su-Gin Chan,Jia En Wu

doi:10.1186/2047-2994-1-36

Abstract

Our prospective-audit-and-feedback antimicrobial stewardship (AS) program for hematology and oncology inpatients was switched from one led by dedicated clinicians to a rotating team of infectious diseases trainees in order to provide learning opportunities and attempt a “de-escalation” of specialist input towards a more protocol-driven implementation. However, process indicators including the number of recommendations and recommendation acceptance rates fell significantly during the year, with accompanying increases in broad-spectrum antibiotic prescription. The trends were reversed only upon reverting to the original setup. Dedicated clinicians play a crucial role in AS programs involving immunocompromised patients. Structured training and adequate succession/contingency planning is critical for sustainability.

Highlights

Our prospective-audit-and-feedback antimicrobial stewardship (AS) program for hematology and oncology inpatients was switched from one led by dedicated clinicians to a rotating team of infectious diseases trainees in order to provide learning opportunities and attempt a “de-escalation” of specialist input towards a more protocol-driven implementation
We had previously shown that a safe and effective prospective audit and feedback antimicrobial stewardship programs (ASPs) led by dedicated consultant-level clinicians could be implemented even in the complex setting of hematology and oncology inpatients within a tertiary university hospital
We present the impact of this personnel change on the ASP’s intervention outcomes and the antimicrobial utilization among hematology-oncology inpatients across 3 years (August 2009 to July 2012) below

Summary

Introduction

Our prospective-audit-and-feedback antimicrobial stewardship (AS) program for hematology and oncology inpatients was switched from one led by dedicated clinicians to a rotating team of infectious diseases trainees in order to provide learning opportunities and attempt a “de-escalation” of specialist input towards a more protocol-driven implementation. Most antimicrobial stewardship practitioners have instead undergone experiential learning during the establishment of their ASPs. We had previously shown that a safe and effective prospective audit and feedback ASP led by dedicated consultant-level clinicians (an infectious diseases physician and a clinical microbiologist) could be implemented even in the complex setting of hematology and oncology inpatients within a tertiary university hospital, Kent Ridge Road, Singapore 119228, Singapore 4Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore Full list of author information is available at the end of the article with broad-spectrum antibiotics reviewed on the 4th and 7th day of prescription [3].

Results

Conclusion