However, as the importance of the work gained heightened awareness, the establishment of antimicrobial stewardship programs was encouraged or required through public health recommendations, state laws, accreditation requirements, and payor policies. 2Īntimicrobial stewardship programs first emerged among high-resource institutions, such as academic medical centers. 1 Without this support, the work to develop, deploy, and determine the effectiveness of antimicrobial stewardship is shouldered by antimicrobial stewardship leaders, few of whom are specialty trained in infectious diseases or program evaluation. Unfortunately, most health systems lack robust infrastructure to support antimicrobial stewardship, with few hospitals providing information technology personnel and salary support for infectious diseases pharmacists and physicians. Major long-term goals of antimicrobial stewardship are to decrease the development of Clostridioides difficile infection and antimicrobial resistance. The ultimate goal of quality improvement and antimicrobial stewardship is also similar: to improve patient safety. Antimicrobial stewardship shares many common elements with quality improvement, including identifying what needs to be improved, implementing strategies to improve antibiotic prescribing, focusing on feasible and high-impact interventions, and measuring program outcomes. Quality improvement departments are necessary to navigate the unique complexities of the facility’s implementation context to develop, deploy, and sustain successful interventions.Īntimicrobial stewardship is a set of strategies to improve and measure antibiotic prescribing by clinicians and antibiotic use by patients. These teams adapt different approaches to identify strategies to support evidence-based health care and determine intervention effectiveness. This infrastructure supports multiple interprofessional teams focused on improving care of a condition (eg, heart failure) and/or patient safety issue (eg, fall prevention). Quality improvement departments have robust infrastructure including information technology, data scientists, and improvement specialists. Entire departments now exist focused on quality or performance improvement to meet regulatory and accreditation standards with a goal to improve patient outcomes and safety. The quality improvement literature emphasizes the use of simple interventions, such as checklists and performance reports, to improve health care. Quality improvement focuses on a modest concept: that we all have room for improvement as clinicians and health systems. Quality improvement, the systematic process to improve health care delivery, has become ubiquitous in health care.
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