SHM Converge Scientific Abstract ePoster Gallery-Relationship Between Hospital-Level Stewardship Initiatives and Reported Antimicrobial Stewardship Performance

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This project examined how feasible and sustainable different antibiotic stewardship interventions are across hospitals, and whether hospital size affects success. Researchers surveyed antibiotic stewardship program leads at 69 hospitals in the Michigan Hospital Medicine Safety Consortium in April–May 2024. Hospitals ranked the feasibility of seven common stewardship interventions and reported whether 43 interventions had been implemented and sustained, implemented but not sustained, attempted but not implemented, or never implemented. Results were analyzed descriptively and compared by hospital bed size using Fisher exact tests, with small hospitals defined as fewer than 200 beds and large hospitals as 200 beds or more.<br /><br />Key findings showed substantial variation in both feasibility and implementation across hospitals and intervention types. Starting new audit-and-feedback programs was viewed as the most feasible new intervention, while clinician peer comparison was considered the least feasible. Once implemented, stewardship interventions were generally sustained. However, implementation and sustainability differed by hospital size.<br /><br />Small hospitals reported significantly higher implementation/sustainability for 5 of 43 interventions, or 11.6% of interventions. These included changes to urine culture testing order sets, two-step urine culture initiatives, an emergency department pneumonia order set that de-emphasized broad-spectrum antibiotics, and daily pharmacy review of antibiotics for urinary tract infections and anti-pseudomonal therapy for pneumonia. No interventions were more likely to be sustained in large hospitals.<br /><br />Overall, the study suggests that antibiotic stewardship success depends on local context, intervention type, and hospital size. Smaller hospitals may face fewer administrative barriers or have smaller patient populations, which may make some interventions easier to implement and maintain. Hospitals should prioritize stewardship strategies based on feasibility and sustainability, not just effectiveness.

Asset Subtitle

Valerie M. Vaughn

Meta Tag

Author List Anurag N. Malani, Ashwin B. Gupta, Elizabeth McLaughlin, Grant Gosden, James D. Harrison, Jennifer K. Horowitz, Julia E. Szymczak, Lindsay A. Petty, Mariam Younas, Robert A. Neetz, Scott A. Flanders, Tejal N. Gandhi, Valerie M. Vaughn

Category Research

Concept Antimicrobial Stewardship

Concept Stewardship Intervention

Concept Antibiotic Use

Concept Implementation

Concept Feasibility

Distinguished Non-Finalist

Presenter Organization Division of General Internal Medicine, Department of Internal Medicine, the University of Utah School of Medicine, Salt Lake City, Utah, USA

Presenting Author Valerie M. Vaughn

Track Quality Improvement

Keywords

antibiotic stewardship

hospital feasibility

sustainability

hospital size

implementation

audit and feedback

Michigan Hospital Medicine Safety Consortium

urine culture testing

pneumonia order set

pharmacy review

Antimicrobial Stewardship

Stewardship Intervention

Antibiotic Use

Implementation

Feasibility