Sustainability of Handshake Stewardship: Extending a Hand Is Effective Years Later

Abstract Background Children’s Hospital Colorado created a unique method of antimicrobial stewardship, called handshake stewardship, that effectively decreased hospital anti-infective use and costs in its pilot year (2013). Handshake stewardship is distinguished by: (1) the lack of prior authorizati...

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Bibliographic Details
Published in:Clinical infectious diseases 2020-05, Vol.70 (11), p.2325-2332
Main Authors: MacBrayne, Christine E, Williams, Manon C, Levek, Claire, Child, Jason, Pearce, Kelly, Birkholz, Meghan, Todd, James K, Hurst, Amanda L, Parker, Sarah K
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents
Antimicrobial Stewardship
Child
Colorado
Hospitals, Pediatric
Humans
Retrospective Studies
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Summary:Abstract Background Children’s Hospital Colorado created a unique method of antimicrobial stewardship, called handshake stewardship, that effectively decreased hospital anti-infective use and costs in its pilot year (2013). Handshake stewardship is distinguished by: (1) the lack of prior authorization; (2) a review of all prescribed anti-infectives; (3) a shared review by the physician and the pharmacist; and (4) a daily, rounding-based, in-person approach to supporting providers. We sought to reevaluate the outcomes of the program after 5 years of experience, totaling 8 years of data. Methods We retrospectively measured anti-infective (antibiotic, antiviral, antifungal) use hospital-wide by unit and by drug for an 8-year period spanning October 2010 to October 2018. Aggregated monthly use was measured in days of therapy per thousand patient days (DOT/1000 PD). The percentage of children admitted ever receiving an anti-infective was also measured, as well as severity-adjusted mortality, readmissions, and lengths of stay. Results Hospital-wide mean anti-infective use significantly decreased, from 891 (95% confidence interval [CI] 859–923) in the pre-implementation phase to 655 (95% CI 637–694) DOT/1000 PD in post-implementation Year 5; in a segmented regression time series analysis, this was a rate of -2.6 DOT/1000 PD (95% CI -4.8 to -0.4). This is largely attributable to decreased antibacterial use, from 704 (95% CI 686–722) to 544 (95% CI 525 –562) DOT/1000 PD. The percentage of children ever receiving an anti-infective during admission likewise declined, from 65% to 52% (95% CI 49–54). There were no detrimental effects on severity adjusted mortality, readmissions, or lengths of stay. Conclusions The handshake method is an effective and sustainable approach to stewardship. Handshake stewardship is an in-person approach to stewardship that is considered a leading practice by the Joint Commission. An 8-year assessment of this method at a large, quaternary-care pediatric hospital confirms it is highly effective in decreasing anti-infective use.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciz650