167 - Communication is Key: A Multifaceted Approach to Improving Essential ASP Metrics in Surgical Services

Background: Despite widespread antimicrobial resistance, suboptimal antimicrobial use is common, particularly among surgical services. Studies show that antimicrobial stewardship programs (ASPs) effectively improve antimicrobial use and decrease adverse events. However, evidence for optimal ASP intervention in surgical departments is lacking, and some surgical services perceive ASPs negatively. This study aimed to evaluate the effect of several collaborative ASP interventions and workflow changes on the non-acceptance rate (NAR) of ASP recommendations and antimicrobial use among surgical services.

Methods: This was a retrospective, pre-post study of services in the department of surgery at a 681-bed, academic medical center between 12/01/2018 and 5/31/2020. Throughout 10/2019 and 11/2019, the core ASP, which consists of two infectious diseases physicians and two infectious diseases pharmacists, performed several interventions with surgical services. These included meetings with the chairman, vice chairs, and division chiefs of the surgery department, a grand rounds presentation to surgical house staff, and monthly surgeon NAR reporting to the chairman. Also, per feedback from surgeons, the ASP began to communicate recommendations directly to attending surgeons instead of residents or via ASP notes in the medical record. Data for the pre-period was collected from 12/2018 to 9/2019; data for the post-period was collected from 12/2019 to 5/2020. Wilcoxson rank sum, chi-square, and Fisher’s exact tests were used to compare outcomes.

Results: The ASP communicated 353 recommendations to surgical services in the pre-period, and 181 in the post-period. ASP offered most recommendations to trauma (n=244), cardiothoracic (n=60), and plastic surgery (n=54) during the study periods. NAR decreased post-intervention overall (43% vs 29%, p=0.0013) and in trauma surgery (63% vs 47%, p=0.03). Mean monthly days of therapy per 1000 patient days trended towards a decrease post-intervention (1105 vs 1044, p=0.26). Cost per 1000 patient days decreased post-intervention ($27,677.91 vs $19,766.31, p =0.0075).

Conclusion: A communicative and adaptive approach to ASP in surgical services improved NAR and antimicrobial costs and trended towards a reduction in antimicrobial use.