Reviewed by James “Brad” Cutrell, MD, FIDSA, UT Southwestern Medical Center
As the demonstrated value of ID consultation and antimicrobial stewardship programs (ASP) grows, the challenge of expanding access to these services for small community hospitals (SCH) in rural areas requires innovative strategies such as telehealth. Vento et al. reported on the Intermountain Healthcare experience providing telehealth ID consultation and ASP support to 16 SCHs in their region from November 2016 to April 2018. This comprehensive program included a 24-hour advice phone line, eConsults, telemedicine ID consultation, as well as ASP surveillance and support from a centralized ID pharmacy team. A total of 2487 physician interactions were logged, with 35% phone calls, 30% eConsults, and 35% telemedicine consults. The most common reason for consultation was bacteremia, particularly for S. aureus, and about 1/3 of all consults led to in-person ID clinic follow-up referrals. Significant reductions in high-use antimicrobials such as vancomycin, meropenem, and fluoroquinolones were seen in 8 ASP projects that were supported by the program. This integrated, comprehensive Telehealth ID and ASP program demonstrates a model example of how SCHs can be supported through collaboration. In attempts to replicate this model in other regions, implementation challenges will still remain for healthcare systems with fewer dedicated telehealth and ID/ASP resources or for SCHs without an existing link to a large health care system.
Vento TJ, Veillette JJ, Gelman SS, et al. Implementation of an Infectious Diseases Telehealth Consultation and Antibiotic Stewardship Program for 16 Small Community Hospitals. Open Forum Infectious Diseases. Volume 8, Issue 6, June 2021, ofab168. Published June 15, 2021. Accessed June 23, 2021. https://doi.org/10.1093/ofid/ofab168