Stewardship at small hospitals: Stretching limited resources

first_imgSmall community hospitals constitute a significant portion of the US healthcare system. In 2015, nearly three quarters of US hospitals had fewer than 200 beds. Every day, in rural and urban areas across the country, these facilities play a critical role in caring for millions of Americans.And while data are limited on antibiotic use in these facilities, recent studies suggest that antibiotic usage in small community hospitals is not much different than it is at larger facilities. In addition, rates of drug-resistance appear to be similar as well. In short, overuse of antibiotics and emerging resistance is just as much an issue at small community hospitals as it is at large academic medical centers.These are some of the reasons why the Joint Commission, the body that accredits nearly 21,000 US healthcare organizations, and the Centers for Medicare and Medicaid Services are now requiring that small community hospitals, like their larger counterparts, have antibiotic stewardship programs (ASPs) in place to promote judicious use of antibiotics and slow the spread of drug-resistant organisms.But if antibiotic stewardship is just as important at small community hospitals, it’s also more difficult to implement. In a 2015 survey, fewer than half of the hospitals with fewer than 200 beds met all of the Centers for Disease Control and Prevention’s (CDC’s) seven core elements of antibiotic stewardship, and only 31% of critical access hospitals (rural hospitals with fewer than 25 beds) had an ASP that met all the core elements.It boils down to a lack of resources, according to a new paper in Clinical Infectious Diseases. Lack of ID, stewardship expertiseAs the review explains, one of the significant stewardship barriers facing small community hospitals is that they often lack infectious disease (ID) physicians and pharmacists, considered a critical part of any ASP. Although guidelines from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America recommend ASPs be led by ID physicians with advanced stewardship training, previous surveys of small hospitals have found that only slightly more than half even have access to ID specialists.  While this makes developing and maintaining stewardship program harder, it’s not impossible, the study’s lead author, Edward Stenehjem, MD, MSc, told CIDRAP News. “We’ve seen examples across the country of small critical access hospitals that have no ID support that develop strong robust, stewardship programs,” Stenehjem said. “So I think you can do it, but it definitely takes dedicated time and resources to be able to feel comfortable with guiding diagnosis and therapy in these patients.”Stenehjem is an infectious disease expert at Intermountain Medical Center in Utah, part of Intermountain Healthcare, a not-for-profit health system that includes 16 small community hospitals. Intermountain is one of four community hospital systems reviewed in the paper, along with Kaiser Permanente Southern California, Colorado Hospital Association, and Hospital Corporation of America.At Intermountain Healthcare, one of the solutions to the lack of in-house ID expertise has been to develop an ID and antibiotic stewardship “telehealth” program, in which an ID physician and ID pharmacist at the system’s central hospital in Salt Lake City provide data, mentorship, and consultation remotely via a toll-free call line.Stenehjem believes this model, just one example of how hospitals can share or pool ID resources, could be replicable, especially for small hospitals that are part of a larger network of hospitals. “We feel that the model we’re developing and showcasing could very well be generalizable to other hospitals and systems,” he said.”The telehealth example…is very innovative, and really takes this model of collaboration and resource pooling for stewardship to the next level and makes it a lot more accessible and feasible,” said David Hyun, MD, a co-author of the study and a senior officer with the Pew Charitable Trusts’ antibiotic resistance project.But not all small community hospitals are part of larger health networks. For those hospitals, the review recommends using commercial telehealth support, and taking advantage of antibiotic stewardship training and assistance being offered by state health departments and hospital associations.Limited staff, limited timeThere are other challenges for small hospitals trying to establish ASPs. Measuring antibiotic usage and identifying areas in which antibiotic prescribing needs improvement, for example, requires a degree of expertise and information technology infrastructure that many small hospitals lack—especially if they aren’t part of a larger network.In addition, while starting an ASP at a small hospital may not necessarily require hiring additional staff, it does require carving out time for physicians, pharmacists, and nurses to focus on stewardship activities, in a way that doesn’t make them feel like they’re being overburdened.”You don’t have an excess amount of staffing in small hospitals; you’re limited in many case to one full-time pharmacist, a handful of physicians, and mid-levels,” Stenehjem said. The question is, “Can the administration designate time…and provide people with resources to get them educated on stewardship?”One answer suggested by Stenehjem and his co-authors is to integrate an ASP into already existing hospital committees, like pharmacy and therapeutics or infection control. Embedding stewardship duties into ongoing efforts to improve quality, Stenehjem suggests, can avoid the sense that hospital administrators are just adding more responsibilities onto staff members’ plates.Hyun and Stenehjem believe all the barriers listed are equally important. “They all share a common theme, because it essentially comes down to resource limitation,” Hyun said, and  limited ID and stewardship expertise, limited staff time, and limited data analysis capacity all affect a small hospital’s ability to develop and maintain a stewardship program.Involving other stakeholdersBut Hyun is hopeful that this paper, which emerged from the experiences shared at a meeting Pew and the CDC held with representatives of small hospitals, is just the first step in a more concerted effort to come up with ways to help small hospitals implement stewardship programs.”There are a lot of different stakeholders who can play a role in helping hospital systems, or individual small hospitals, to achieve stewardship programs,” Hyun said. These stakeholders include hospital associations, state and regional health agencies, and medical organizations. Hyun said Pew and the CDC recently met with the American Hospital Association to focus specifically on ways to implement stewardship programs in critical access hospitals.Stenehjem is hopeful, too, that getting the ID community and other stakeholders involved will help small hospitals overcome the stewardship challenges they face. But he acknowledges that it will be an uphill climb.”I think we’re getting traction, we’re getting movement, but it certainly will take a while,” he said. “There are lots of small hospitals that need to develop these programs and maintain them.”See also:May 2 Clin Infect Dis articlelast_img read more

Wonders & blunders

first_imgTo continue enjoying Building.co.uk, sign up for free guest accessExisting subscriber? LOGIN Stay at the forefront of thought leadership with news and analysis from award-winning journalists. Enjoy company features, CEO interviews, architectural reviews, technical project know-how and the latest innovations.Limited access to building.co.ukBreaking industry news as it happensBreaking, daily and weekly e-newsletters Subscribe to Building today and you will benefit from:Unlimited access to all stories including expert analysis and comment from industry leadersOur league tables, cost models and economics dataOur online archive of over 10,000 articlesBuilding magazine digital editionsBuilding magazine print editionsPrinted/digital supplementsSubscribe now for unlimited access.View our subscription options and join our community Subscribe now for unlimited access Get your free guest access  SIGN UP TODAYlast_img read more

LMWD board member resigns

first_img Share By ESTEVAN MEDRANOPort Isabel-South Padre [email protected] 22, 2015Nancy Martinez, member of the Laguna Madre Water District Board, has submitted her Letter of Resignation less than two months after being sworn in following a narrow victory over John Thobe for the position in the November election. The board officially accepted the document of notification January 8 at a formal meeting. Martinez cites personal reasons for the decision to part ways with the board, feeling she would not have the time needed to commit to the office after accepting a job position in Lubbock.This resignation would also allow her to be closer to her son who is attending school, according to Carlos Galvan, LMWD general manager. Galvan assured the public that the board can and will still perform with efficiency, making significant decisions, and serving the area despite the open office seat.“The board will continue to function as it should until we appoint a representative to the position,” Galvan said. He went on to say that no one has officially been chosen yet, but encourages anyone in the community who feels they can serve the area for the better to consider being a part of the board. “The board is open-minded if anyone is interested in the position.”As required by state law, the board has 90 days to appoint someone to occupy the position.Want the whole story? Pick up a copy of the Port Isabel-South Padre Press, or subscribe to our E-Edition by clicking here. RelatedLMWD searches for new finance directorBy DINA ARÉVALO Port Isabel-South Padre Press [email protected] The Laguna Madre Water District (LMWD) has begun its search for a new director of finance this week. “She’s no longer with the district,” said General Manager Carlos Galvan of Sanjuana Garcia, who served as the district’s finance director for just over two…December 15, 2017In “News”Water district bids adieu to CantuBy PAMELA CODY Special to the PRESS The Laguna Madre Water District Board of Directors said farewell to one of its members as they accepted the resignation of Martin Cantu, Jr. during a regular meeting Wednesday. Cantu was not present, but Chairman Jeff Keplinger recognized Cantu, saying, “We appreciate Mr.…May 27, 2016In “News”Cantu appointed to LMWD boardBy ESTEVAN MEDRANO and DINA ARÉVALO Port Isabel-South Padre Press [email protected] The Laguna Madre Water District welcomed their newest board member Martin Cantu Jr., who was appointed and sworn in Feb. 11 as the replacement for Nancy Martinez. Martin, a product of the University of Texas at Brownsville, was selected among…March 8, 2015In “News”last_img read more

LOOT.BET teams up with Esports Integrity Commission

first_imgEsports-dedicated bookmaker LOOT.BET has announced its involvement with the Esports Integrity Commission (ESIC).Joining as an anti-corruption supporter and part of ESIC’s betting alert network the bookmaker will provide internal data for initiating and conducting investigations.Logo credits: LOOT.BET, Esports Integrity CommissionIan Smith, Commissioner of Esports Integrity Commission commented in a release: “In reaching our goal which is to make esports as fair as possible, bookmakers play a crucial role since their internal data analysis makes it easier to recognize the signs of a rigged match. We’ve been working in cooperation with LOOT.BET for months by now, and the bookmaker proved their readiness for full collaboration and has already helped us in one of our investigations.“We’re glad to officially welcome LOOT.BET as our new Anti Corruption Supporter. We believe that signing the Memorandum of Understanding with them is another step towards the future where esports is free from corruption and fraud.” Esports Integrity Commission recently announced its rebrand from Esports Integrity Coalition at ESI London. The not-for-profit explained it had changed its identity to “more meaningfully target the integrity needs of the esports industry.”Paul Brel, Head of Communications at Livestream Ltd added: “As a major esports bookmaker, we’re deeply interested in high trust not only in our brand in particular but in betting and esports in general. That’s why for us, being a part of the ESIC’s mission in both an honor and in a certain degree a pleasant need.“ESIC’s infrastructure, experience, and expertise will help us and the whole industry to more effectively detect match-fixing and protect ourselves as well as our customers from possible harm caused by third party’s illicit activities. Besides, we’re happy to join ESIC as a regular sponsor of esports events since, in this status, we’re standing for those tournaments’ integrity more than anyone else.”Esports Insider says: It’s great to see another company join the Esports Integrity Commission. With esports betting on the rise, it’s important that companies like LOOT.BET work to monitor, support, and cleanse the industry. Subscribe to ESI on YouTubelast_img read more

Miller gives back to Utah

first_imgE-mail: [email protected] When he came to the University of Utah in 1994, he was a shy, slightly overweight point guard who had to pay his way through school his first year. He still remembers walking on to campus his first day and feeling “nervous.”Andre Miller eventually got his degree on time, became an All-American and helped lead the Utes to the national championship game in 1998. Since joining the NBA in 1999, Miller has been one of the NBA’s top point guards and now plays for the Denver Nuggets.On Tuesday, Miller donated $500,000 back to his alma mater’s athletic department. Of the money, $300,000 has been earmarked for an endowed scholarship and $200,000 will go to help fund the basketball team room renovation.Miller said he’s always wanted to give back to the university and met with U. officials last fall to discuss the options. With all the details being ironed out and the Nuggets in Utah for a game tonight, the announcement was made Tuesday.”I am very fortunate to be in a position where I can give back and help others,” Miller said. “I’ve been trying to prepare myself to be able to give back and help other people, whether it’s the university or kids, and see them benefit. The University of Utah opened a lot of doors for me and hopefully this scholarship will do the same for someone else.”Utah athletic director Chris Hill was emotional as he talked about Miller and how far he’s come since first coming to Utah. He called it “a very special day for the University of Utah” and said the contribution was “one of the top things I’ve experienced since I’ve been here.”Hill read a letter he received from Miller, thanking the university for “changing my life,” and said he cherishes it so much he had it laminated.”It is the ultimate compliment for a student-athlete to give money at such a young age back to his university,” Hill said. “All of our contributions are valuable and this one’s especially valuable because of who it’s from and what it means to him endorsing his experience at the University of Utah.”Miller thanked everyone from the ski team to the media and also paid tribute to former Utah coach Rick Majerus, who he said was a big part of his development.”He prepared me for basketball and how to live my life and always made sure I was going to get my education,” Miller said.Utah coach Ray Giacoletti said he wished he had a chance to coach Miller and has appreciated getting to know him the last two summers when Miller came back to help with the Utah basketball camp.”To give back to the university like that is unbelievable,” Giacoletti said.Last year, another Ute basketball player, Andrew Bogut, donated $125,000 to the university to help upgrade the Ute basketball locker rooms, and the money from Miller will help complete the project.Hill explained the scholarship, called the Andre Miller Point Guard Scholarship, is a permanent one and is the 16th endowed scholarship overall for athletics.”This solidifies one portion of our program and allows us to expand and fund other parts of our program,” he said.Miller came to Utah in 1995 as a non-qualifier academically and had to sit out his first year. He became a starter his freshman season and eventually earned All-American honors and helped lead Utah to the 1998 national championship game against Kentucky.He graduated that year and was able to gain an extra year of eligibility, and in 1999 he was the runner-up for the John R. Wooden Award. Miller said he still follows Utah basketball and keeps in touch with his former teammates. He also said he tries to steer kids toward the university and even has a cousin, Shyra Porter, “a regular student” who is a freshman at the U. last_img read more