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Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

Published online by Cambridge University Press:  02 January 2015

Harold C. Standiford ,
Shannon Chan ,
Megan Tripoli ,
Elizabeth Weekes  and
Graeme N. Forrest
Harold C. Standiford*
Affiliation:
University of Maryland Medical Center, Baltimore, Maryland Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Shannon Chan
Affiliation:
Department of Pediatrics, A. I. DuPont Hospital for Children, Wilmington, Delaware
Megan Tripoli
Affiliation:
University of Maryland Medical Center, Baltimore, Maryland
Elizabeth Weekes
Affiliation:
Department of Pharmacy, Denver Health, Denver, Colorado
Graeme N. Forrest
Affiliation:
Division of Infectious Diseases, Portland Veterans Affairs Medical Center, Portland, Oregon
*
University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Baltimore, MD 21201 (hstandiford@umm.edu)
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Abstract

Background.

An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.

Design.

A descriptive cost analysis before, during, and after the program.

Patients/Setting.

A large tertiary care teaching medical center.

Methods.

Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.

Results.

The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.

Conclusions.

The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 4: Special Topic Issue: Antimicrobial Stewardship , April 2012 , pp. 338 - 345
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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