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Mularoni A, Adamoli L, Polidori P, Ragonese B, Gioè SM, Pietrosi A, Tuzzolino F, Guadagnino G, Monaco F, Grossi PA, Conaldi PG, Luca A, Mikulska M. How can we optimise antifungal use in a solid organ transplant centre? Local epidemiology and antifungal stewardship implementation: A single-centre study. Mycoses 2020; 63:746-754. [PMID: 32358860 DOI: 10.1111/myc.13098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE We aimed to implement and to assess the impact of the antifungal stewardship programme (AFSp) on prescription appropriateness of antifungals, management and outcomes of candidaemia patients, and antifungal consumption and costs at our solid organ transplant (SOT) institute. METHODS Local epidemiology of invasive fungal infections (IFIs) from 2009 to 2017 was analysed in order to prepare an effective AFSp, implemented in January 2018. It included suspension of empirical antifungal prescriptions after 72 hours (antifungal time-out), automated alert and infectious disease (ID) consult for empirical prescriptions and for every patient with IFI, and indication for step-down to oral fluconazole when possible. We used process measures and results measures to assess the effects of the implemented programme. RESULTS The ASFp led to significant improvements in selection of the appropriate antifungal (40.5% in pre-AFS vs 78.6% in post-AFS), correct dosing (51.2% vs 79.8%), correct length of treatment (55.9% vs 75%) and better management of patients with candidaemia. Analysis of prescribed empirical antifungal revealed that defined daily doses (DDDs) per 100 patient days decreased by 36.7% in 2018 compared to the average of pre-AFSp period, with important savings in costs. CONCLUSION This AFSp led to a better use of antifungal drugs in terms of appropriateness and consumption, with stable clinical and microbiological outcomes in patients with IFI.
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Affiliation(s)
- Alessandra Mularoni
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Lucia Adamoli
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Piera Polidori
- Clinical Pharmacy Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Barbara Ragonese
- Department of Accreditation and Quality, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Santi Mauro Gioè
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Astrid Pietrosi
- Department of Management Control and Decision Support, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Fabio Tuzzolino
- Research Office, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Giuliana Guadagnino
- Department of Infectious and Tropical Diseases, St. Annunziata Hospital, Cosenza, Italy
| | - Francesco Monaco
- Laboratory of Clinical Pathology, Microbiology, and Virology, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Paolo Antonio Grossi
- Clinica delle Malattie Infettive e Tropicali, Università degli Studi dell'Insubria, Varese, Italy
| | - Pier Giulio Conaldi
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Angelo Luca
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
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Abstract
PurposeIn the healthcare management domain, there is a lack of knowledge concerning the role of resilience practices in improving patient safety. The purpose of this paper is to understand the capabilities that enable healthcare resilience and how digital technologies can support these capabilities.Design/methodology/approachWithin- and cross-case research methodology was used to study resilience mechanisms and capabilities in healthcare and to understand how digital health technologies impact healthcare resilience. The authors analyze data from two Italian hospitals through the lens of the operational failure literature and anchor the findings to the theory of dynamic capabilities.FindingsFive different dynamic capabilities emerged as crucial for managing operational failure. Furthermore, in relation to these capabilities, medical, organizational and patient-related knowledge surfaced as major enablers. Finally, the findings allowed the authors to better explain the role of knowledge in healthcare resilience and how digital technologies boost this role.Practical implicationsWhen trying to promote a culture of patient safety, the research suggests healthcare managers should focus on promoting and enhancing resilience capabilities. Furthermore, when evaluating the role of digital technologies, healthcare managers should consider their importance in enabling these dynamic capabilities.Originality/valueAlthough operations management (OM) research points to resilience as a crucial behavior in the supply chain, this is the first research that investigates the concept of resilience in healthcare systems from an OM perspective, with only a few authors having studied similar concepts, such as “workaround” practices.
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Raffa GM, Wu B, Pasta S, Morsolini M, Bellavia D, Romano G, Falletta C, Pietrosi A, Scardulla C, Pilato M. Patients with bicuspid aortic valve are likely to receive an aortic valve prosthesis during prophylactic resection of their ascending aortic aneurysm. Int J Cardiol 2016; 206:97-100. [PMID: 26785033 DOI: 10.1016/j.ijcard.2016.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/25/2015] [Accepted: 01/01/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
| | - Bryan Wu
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | | | - Marco Morsolini
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Giuseppe Romano
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Calogero Falletta
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Astrid Pietrosi
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Cesare Scardulla
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
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Raffa GM, D'Ancona G, Sciacca S, Pietrosi A, Hernandez Baravoglia CM, Turrisi M, Romano G, Armaro A, Stringi V, Clemenza F, Pilato M. Systemic or Endoventricular Thrombolysis to Treat HeartWare Left Ventricle Assist Device Thrombosis: A Clinical Dilemma. Artif Organs 2015; 39:526-9. [DOI: 10.1111/aor.12423] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Giuseppe M. Raffa
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Giuseppe D'Ancona
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Sergio Sciacca
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Astrid Pietrosi
- Department of Management Control and Decision Support; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Cesar M. Hernandez Baravoglia
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Marco Turrisi
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Giuseppe Romano
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Alessandro Armaro
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Vincenzo Stringi
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Francesco Clemenza
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
| | - Michele Pilato
- Cardiac Surgery and Heart Transplantation Unit; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT); Palermo Italy
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Raffa GM, D'Ancona G, Romano G, Falletta C, Sciacca S, Todaro C, Tuzzolino F, Pietrosi A, Amaducci A, Clemenza F, Scardulla C, Pilato M. Should device replacement be the first choice strategy in continuous-flow left ventricle assist device thrombosis? Analysis of 9 events and results after endoventricular thrombolysis. Int J Cardiol 2014; 178:159-61. [PMID: 25464242 DOI: 10.1016/j.ijcard.2014.10.169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 01/14/2023]
Affiliation(s)
- Giuseppe Maria Raffa
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.
| | - Giuseppe D'Ancona
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Giuseppe Romano
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Calogero Falletta
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Sergio Sciacca
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Chiara Todaro
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Fabio Tuzzolino
- Statistical Office, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Astrid Pietrosi
- Management Control and Decision Support, University of Pittsburgh Medical Center Italy (UPMC Italy), Palermo, Italy
| | - Andrea Amaducci
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Francesco Clemenza
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Cesare Scardulla
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Michele Pilato
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
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