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Swartz TH, Aberg JA. Preserving the Future of Infectious Diseases: Why We Must Address the Decline in Compensation for Clinicians and Researchers. Clin Infect Dis 2023; 77:1387-1394. [PMID: 37436703 DOI: 10.1093/cid/ciad416] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
Infectious diseases (ID) physicians play a pivotal role in patient care and public health, yet concerns are mounting about their under-compensation compared with other medical specialties. This trend sees ID physicians, including new graduates, receiving lower remuneration than their general and hospital medicine peers, despite their significant contributions. The persistent disparity in compensation has been identified as a key factor behind the declining interest in the ID specialty among medical students and residents, potentially threatening patient care quality, research advancement, and diversity within the ID workforce. This viewpoint underscores the urgent need for the ID community to rally behind the Infectious Diseases Society of America in advocating for fair compensation for ID physicians and researchers. While focusing on wellness and work-life balance is vital, it is critical to address compensation, a significant source of distress for physicians. Failure to confront the issue of under-compensation promptly may jeopardize the future growth and sustainability of the ID specialty.
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Affiliation(s)
- Talia H Swartz
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Rogers NG, Carrillo-Marquez M, Carlisle A, Sanders CD, Burge L. Friends Not Foes: Optimizing Collaboration with Subspecialists. Orthop Clin North Am 2023; 54:277-285. [PMID: 37271556 DOI: 10.1016/j.ocl.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pediatric orthopedic patients can be complex to manage. As orthopedists plan for possible surgical interventions, consultation with pediatric subspecialists will be necessary. This article discusses the considerations an orthopedist should make when deciding on the timing and the appropriateness of consultation-both preoperatively and perioperatively. Consultation before surgical intervention will especially be useful if the subspecialist will be collaborating in the management of the condition postoperatively (whether inpatient or outpatient). Clear and early consultation in both written and verbal format will facilitate quality and expedite the patient's care.
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Affiliation(s)
- Nathaniel G Rogers
- Division of Pediatric Hospital Medicine, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA.
| | - Maria Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Annette Carlisle
- Division of Allergy & Immunology, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Catherine D Sanders
- Division of Pulmonology, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
| | - Lauren Burge
- Division of Child Abuse, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN 38103, USA
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3
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Goodman KE, Heil EL, Claeys KC, Banoub M, Bork JT. Real-World Antimicrobial Stewardship Experience in a Large Academic Medical Center: Using Statistical and Machine Learning Approaches to Identify Intervention “Hotspots” in an Antibiotic Audit and Feedback Program. Open Forum Infect Dis 2022; 9:ofac289. [PMID: 35873287 PMCID: PMC9297307 DOI: 10.1093/ofid/ofac289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/07/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
Prospective audit with feedback (PAF) is an impactful strategy for antimicrobial stewardship program (ASP) activities. However, because PAF requires reviewing large numbers of antimicrobial orders on a case-by-case basis, PAF programs are highly resource-intensive. The current study aimed to identify predictors of ASP intervention (i.e., feedback), and to build models to identify orders that can be safely bypassed from review, to make PAF programs more efficient.
Methods
We performed a retrospective cross-sectional study of inpatient antimicrobial orders reviewed by the University of Maryland Medical Center’s PAF program between 2017–2019. We evaluated the relationship between antimicrobial and patient characteristics with ASP intervention using multivariable logistic regression models. Separately, we built prediction models for ASP intervention using statistical and machine learning approaches and evaluated performance on held-out data.
Results
Across 17,503 PAF reviews, 4,219 (24%) resulted in intervention. In adjusted analyses, a clinical pharmacist on the ordering unit or receipt of an ID consult were associated with 17% and 56% lower intervention odds, respectively (aORs 0.83 and 0.44, P values ≤ 0.001). Fluoroquinolones had the highest adjusted intervention odds (aOR 3.22, 95% CI: 2.63–3.96). A machine learning classifier (C-statistic 0.76) reduced reviews by 49% while achieving 78% sensitivity. A “workflow simplified” regression model that restricted to antimicrobial class and clinical indication variables, two strong machine-learning-identified predictors, reduced reviews by one-third while achieving 81% sensitivity.
Conclusions
Prediction models substantially reduced PAF review caseloads while maintaining high sensitivities. Our results and approach may offer a blueprint for other ASPs.
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Affiliation(s)
- Katherine E Goodman
- Correspondence: Katherine E. Goodman, JD, PhD, University of Maryland School of Medicine, 10 S Pine St, Baltimore, MD 21201, USA ()
| | - Emily L Heil
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Kimberly C Claeys
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Mary Banoub
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jacqueline T Bork
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Zimmermann N, Allen R, Fink G, Först G, Kern WV, Farin-Glattacker E, Rieg S. Antimicrobial Stewardship with and without Infectious Diseases Specialist Services to Improve Quality-of-Care in Secondary and Tertiary Care Hospitals in Germany: Study Protocol of the ID ROLL OUT Study. Infect Dis Ther 2021; 11:617-628. [PMID: 34751941 PMCID: PMC8576457 DOI: 10.1007/s40121-021-00552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship (AMS) programs aim to secure the rational prescription of antibiotics through implementing department- or hospital-level activities. Infectious disease (ID) specialists improve the quality of care and outcomes in infection patients predominantly by individual consultations and patient-level interventions. While hospital AMS programs are established to various extents in Germany, ID specialist services are rarely available in this country. In the ID ROLL OUT study, we will implement and evaluate hospital-level AMS tools with and without ID specialist services in secondary and tertiary care hospitals. We aim to identify means to comprehensively and sustainably improve the quality of care of patients with infectious diseases. METHODS This project is a clustered, two-armed intervention study, which will be conducted in ten secondary and tertiary (non-university) care hospitals in Germany. The intervention groups are stratified by key characteristics of the hospitals. We will compare two interventional strategies: implementation of AMS teams and implementation of AMS teams combined with the activities of ID specialists (AMS + IDS). PLANNED OUTCOMES The primary outcome is the quality of care as measured in changes in a Staphylococcus aureus bacteremia (SAB) score (as an indicator of difficult-to-treat infections) and a community-acquired pneumonia (CAP) score (as an indicator of common infections) compared to a baseline pre-interventional period. Our secondary outcomes comprise patient- and hospital-level outcomes, such as the quality and frequency of antibiotic treatment, in-hospital mortality, duration of hospitalization, and C. difficile incidence (associated diarrhea episodes). The study may provide urgently needed key information for the aspired advancement of ID care in Germany. TRIAL REGISTRATION DRKS00023710 (registered on 9th April 2021).
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Affiliation(s)
- Nicole Zimmermann
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Centre, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Rebekka Allen
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Centre, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Geertje Fink
- Division of Infectious Diseases, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Gesche Först
- Division of Infectious Diseases, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Centre, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
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5
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Antibiotic overuse after discharge from medical short-stay units. Infect Control Hosp Epidemiol 2021; 43:1689-1692. [PMID: 34425932 DOI: 10.1017/ice.2021.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Of 100 patients discharged from short-stay units (SSUs) with antibiotics, 47 had a skin and soft-tissue infection, 22 had pneumonia, and 21 had a urinary tract infection. Among all discharge antibiotic prescriptions, 78% involved antibiotic overuse, most commonly excess duration (54 of 100) and guideline discordant selection (44 of 100).
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Suzuki H, Perencevich E, Goto M, Alexander B, Nair R, Puig-Asensio M, Ernst E, Livorsi DJ. A comprehensive assessment of carbapenem use across 90 Veterans Health Administration hospitals with defined stewardship strategies for carbapenems. J Antimicrob Chemother 2021; 76:1358-1365. [PMID: 33523128 DOI: 10.1093/jac/dkab008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/29/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Carbapenems are an important target for antimicrobial stewardship (AS) efforts. In this study, we sought to compare different hospital-based strategies for improving carbapenem use. METHODS We analysed a cohort of all patients hospitalized at Veterans Health Administration (VHA) acute care hospitals during 2016 and a mandatory survey that characterized each hospital's carbapenem-specific AS strategy into one of three types: no strategy (NS), prospective audit and feedback (PAF) or restrictive policies (RP). Carbapenem use was compared using risk-adjusted generalized estimating equations that accounted for clustering within hospitals. Two infectious disease (ID) physicians independently performed manual chart reviews in 425 randomly selected cases. Auditors assessed carbapenem appropriateness with an assessment score on Day 4 of therapy. RESULTS There were 429 062 admissions in 90 sites (24 NS, 8 PAF, 58 RP). Carbapenem use was lower at PAF than NS sites [rate ratio (RR) 0.6 (95% CI 0.4-0.9); P = 0.01] but similar between RP and NS sites. Carbapenem prescribing was considered appropriate/acceptable in 215 (50.6%) of the reviewed cases. Assessment scores were lower (i.e. better) at RP than NS sites (mean 2.3 versus 2.7; P < 0.01) but did not differ significantly between NS and PAF sites. ID consultations were more common at PAF/RP than NS sites (51% versus 29%; P < 0.01). ID consultations were associated with lower (i.e. better) assessment scores (mean 2.3 versus 2.6; P < 0.01). CONCLUSIONS In this VHA cohort, PAF strategies were associated with lower carbapenem use and ID consultation and RP strategies were associated with more appropriate carbapenem prescribing. AS and ID consultations may work complementarily and hospitals could leverage both to optimize carbapenem use.
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Affiliation(s)
- Hiroyuki Suzuki
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Eli Perencevich
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Michihiko Goto
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bruce Alexander
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Rajeshwari Nair
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Erika Ernst
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Daniel J Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Heil EL, Bork JT. It Is a Marathon, Not a Sprint-Sustainability of Stewardship in ICUs. Crit Care Med 2021; 49:159-161. [PMID: 33337745 DOI: 10.1097/ccm.0000000000004714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Emily L Heil
- Division of Infectious Diseases, Department of Medicine, University of School of Maryland Medicine, Baltimore, MD
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Nguyen CT, Olson G, Pho MT, Lew AK, Pitrak D, Saltzman J, Hazra A, Pursell K, Pettit NN. Automatic ID Consultation for Inpatients With COVID-19: Point, Counterpoint, and a Single-Center Experience. Open Forum Infect Dis 2020; 7:ofaa318. [PMID: 33117849 PMCID: PMC7454912 DOI: 10.1093/ofid/ofaa318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/27/2020] [Indexed: 01/18/2023] Open
Abstract
There are many unknowns with regard to COVID-19 clinical management, including the role of Infectious Diseases Consultation (IDC). As hospitalizations for COVID-19 continue, hospitals are assessing how to optimally and efficiently manage COVID-19 inpatients. Typically, primary teams must determine when IDC is appropriate, and ID clinicians provide consultation upon request of the primary team. IDC has been shown to be beneficial for many conditions; however, the impact of IDC for COVID-19 is unknown. Herein, we discuss the potential benefits and pitfalls of automatic IDC for COVID-19 inpatients. Important considerations include the quality of care provided, allocation and optimization of resources, and clinician satisfaction. Finally, we describe how automatic IDC changed throughout the COVID-19 pandemic at a single academic medical center.
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Affiliation(s)
- Cynthia T Nguyen
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
| | - Gregory Olson
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Alison K Lew
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
| | - David Pitrak
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jina Saltzman
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Aniruddha Hazra
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kenneth Pursell
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Natasha N Pettit
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
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