“Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable and making other medical advances, like cancer chemotherapy and organ transplants, possible,” according to the CDC. However, that transformation did not come without side effects. As Mark Twain once said, “To a man with a hammer, everything looks like a nail.” Antibiotics have proven to be such an effective hammer that as much as 50% of all antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate. Further, conditions like sepsis require an aggressive and rapid antibiotic response – mortality increases by 7% for every hour that antibiotic treatment is delayed. Throw in the threat of penalties from CMS and you have the perfect storm for overuse.

Why is Antibiotic Overuse Such a Problem?

First, antibiotic overuse leads to antibiotic resistance. In 2016, the UN secretary general, Ban Ki-moon, said antimicrobial resistance is a “fundamental threat” to global health. The Society of Healthcare Epidemiology of America (SHEA) adds that “the dramatic drop in the development and approval of new antibacterial agents complicates this global health problem and portends a future in which many more infections have no effective treatment option.”

Second, the use of antibiotics can lead to secondary risks such as Clostridium difficile, which itself is associated with 29,000 deaths per year.

Enter Infectious Disease Management

Infectious Disease management requires collaboration amongst an interdisciplinary team that includes hospitalists, specialists, pharmacists, microbiologists and others. The team works together to evaluate patients and determine the best treatment, including the safest and most effective (and most cost effective) use of antibiotics.  Dr. Lucas Schulz, an infectious disease pharmacist and infectious diseases clinical coordinator at the University of Wisconsin Hospitals and Clinics, tells us that this is no simple task. Schulz and one other clinician can review upwards of 350 patients in a single day. That means, assuming they both work a 12-hour shift, they’ll have a little more than four minutes to review each patient’s microbiology results, lab results, the type and breadth of antibiotics being administered, and other real-time clinical data, AND THEN figure out where the patient is in the context of the institution’s overall treatment program, consider best practices and recent studies, and recommend next steps to care teams. Given that the average person can keep track of around four variables at a time; this seems like an incredibly difficult job, and one that can likely be improved.

The Role of Antimicrobial Stewardship

Where infectious disease management involves real-time decision making for an individual patient, Dr. Schulz tells us that “antimicrobial stewardship is the oversite of antimicrobials across the entire enterprise.” That means understanding the specific antibiotic susceptibilities of the bacteria that presents at this hospital (i.e. the hospital antibiogram), tracking the program and all of the associated variables over time, and managing an effective outreach program. Basically, you take the difficulty of infectious disease management, multiply it by the 350 patients Dr. Schulz sees each day, and scale it out over a period of months and years, incorporating the advancement of medicine and antimicrobial resistance along the way. This too seems like an incredibly difficult job.

How can Information Technology (IT) and Clinical Decision Support (CDS) Tools Help?

The opportunity here is not to build artificial intelligence to replace the doctors, or even to tell the doctors what to do. Instead, the promise of IT and CDS tools is that they can evaluate hundreds of variables in real-time, consider them against the patient’s current place in their care journey and align all of that with industry best practices and the local enterprise stewardship program to make the best decision for a given patient at a specific point in time. In short, these tools enable Dr. Schulz and his counterparts to make the best use of those four minutes they have for each patient, to improve outcomes, reduce costs, and effectively manage infectious disease.

Further, IT and CDS enable a holistic and long-term view of all the patients being treated by this institution. That means our antimicrobial stewardship plan will be informed over-time by the actual results being driven by the program, and comparable back to the actual steps taken. As Dr. Schulz puts it, IT and CDS “help us move from anecdotal to evidenced-based medicine.”

Listen to the full interview w/ Dr. Lucas Schulz where he discusses his role as the infectious diseases clinical coordinator at University of Wisconsin Health. Additionally, Dr. Schulz tells us how he is leveraging his real-world experience in infectious disease management and antimicrobial stewardship to advise ILÚM Health Solutions as they develop technology that leverages IT and clinical data to maximize the impact of quality programs.

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