Monday Lea M, Yazdanpaneh Omid, Sokolowski Caleb, Chi Jane, Kuhn Ryan, Bazzy Kareem, Dhar Sorabh
Department of Internal Medicine, Division of General Internal Medicine, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
Department of Internal Medicine, Division of General Internal Medicine, Detroit Medical Center, Detroit, MI, USA.
Glob J Qual Saf Healthc. 2021 Jun 25;4(3):109-116. doi: 10.36401/JQSH-21-2. eCollection 2021 Aug.
The Infectious Diseases Society of America (IDSA) recommends a minimum of 5 days of antibiotic therapy in stable patients who have community-acquired pneumonia (CAP). However, excessive duration of therapy (DOT) is common. Define, measure, analyze, improve, and control (DMAIC) is a Lean Six Sigma methodology used in quality improvement efforts, including infection control; however, the utility of this approach for antimicrobial stewardship initiatives is unknown. To determine the impact of a prospective physician-driven stewardship intervention on excess antibiotic DOT and clinical outcomes of patients hospitalized with CAP. Our specific aim was to reduce excess DOT and to determine why some providers treat beyond the IDSA minimum DOT.
A single-center, quasi-experimental quality improvement study evaluating rates of excess antimicrobial DOT before and after implementing a DMAIC-based antimicrobial stewardship intervention that included education, prospective audit, and feedback from a physician peer, and daily tracking of excess DOT on a Kaizen board. The baseline period included retrospective CAP cases that occurred between October 2018 and February 2019 (control group). The intervention period included CAP cases between October 2019 and February 2020 (intervention group).
A total of 123 CAP patients were included (57 control and 66 intervention). Median antibiotic DOT per patient decreased (8 versus 5 days; < 0.001), and the proportion of patients treated for the IDSA minimum increased (5.3% versus 56%; < 0.001) after the intervention. No differences in mortality, readmission, length of stay, or incidence of infection were observed between groups. Almost half of the caregivers surveyed were aware that as few as 5 days of antibiotic treatment could be appropriate.
A physician-driven antimicrobial quality improvement initiative designed using DMAIC methodology led to reduced DOT and increased compliance with the IDSA treatment guidelines for hospitalized patients with CAP reduced without negatively affecting clinical outcomes.
美国传染病学会（IDSA）建议，对于患有社区获得性肺炎（CAP）的稳定患者，抗生素治疗至少持续5天。然而，治疗时间过长（DOT）的情况很常见。定义、测量、分析、改进和控制（DMAIC）是精益六西格玛方法，用于质量改进工作，包括感染控制；然而，这种方法在抗菌药物管理举措中的效用尚不清楚。为了确定前瞻性医生主导的管理干预对CAP住院患者抗生素DOT过长及临床结局的影响。我们的具体目标是减少DOT过长情况，并确定为何一些医疗服务提供者的治疗时间超过了IDSA建议的最短DOT。
一项单中心、准实验性质量改进研究，评估在实施基于DMAIC的抗菌药物管理干预前后抗菌药物DOT过长的发生率，该干预包括教育、前瞻性审核、医生同行反馈，以及在改善情况公告板上每日跟踪DOT过长情况。基线期包括2018年10月至2019年2月期间发生的回顾性CAP病例（对照组）。干预期包括2019年10月至2020年2月期间的CAP病例（干预组）。
共纳入123例CAP患者（57例对照组和66例干预组）。干预后，每位患者的抗生素DOT中位数下降（8天对5天；P<0.001），接受IDSA建议最短治疗时间的患者比例增加（5.3%对56%；P<0.001）。两组之间在死亡率、再入院率、住院时间或感染发生率方面未观察到差异。几乎一半接受调查的护理人员意识到，仅5天的抗生素治疗可能就足够了。
采用DMAIC方法设计的医生主导的抗菌药物质量改进举措，减少了DOT，并提高了住院CAP患者对IDSA治疗指南的依从性，且未对临床结局产生负面影响。
