A Needs Assessment for Infectious Diseases Consultation in Community Hospitals

• Published in: Infectious diseases and therapy Vol. 12; no. 6; pp. 1725 - 1737
• Main Authors: Hollingshead, Caitlyn M., Khazan, Ana E., Franco, Justin H., Ciricillo, Jacob A., Haddad, Michael N., Berry, Julia T., Kammeyer, Joel A.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-06-2023; Springer; Springer Nature B.V; Adis, Springer Healthcare
• Subjects: Anti-infective agents; Antimicrobial agents; Brief Report; Care and treatment; Chronic obstructive pulmonary disease; Communicable diseases; Community hospitals; Consultation; Health aspects; Hospitals; Infection; Infectious disease; Infectious Diseases; Internal Medicine; Lung diseases, Obstructive; Medical colleges; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Needs analysis; Needs assessment; Patients; Public health; Rural areas; Rural health; Rural health care; Staphylococcal infections; Ohio; Michigan; Rural health; Infectious disease; Community hospitals; Needs assessment; Consultation
• ISSN: 2193-8229; 2193-6382
• DOI: 10.1007/s40121-023-00810-4

Introduction
Infectious diseases (ID) consultations have been demonstrated to improve patient outcomes in the treatment of severe infections. However, ID consultation is often unavailable to patients that live in rural communities. Little is known regarding the treatment of infections in rural hospitals with no coverage from an ID specialist. We characterized the outcomes of patients cared for in hospitals without coverage from an ID physician.
Methods
Patients aged 18 years or older admitted to eight community hospitals without access to ID consultation during a 6.5-month period were assessed. All patients had received at least three days of continuous antimicrobial therapy. The primary outcome was the need for transfer to a tertiary facility for ID services. The secondary outcome was the characterization of antimicrobials received. Antimicrobial courses were evaluated independently by two board-certified ID physicians.
Results
3706 encounters were evaluated. Transfers for ID consultation occurred in 0.01% of patients. The ID physician would have made modifications in 68.5% of patients. Areas for improvement included treatment of chronic obstructive pulmonary disease exacerbations, broad-spectrum treatment of skin and soft tissue infection, long courses of azithromycin, and management of
Staphylococcus aureus
bacteremia, including choice and length of therapy, as well as obtaining echocardiography. Patients evaluated received 22,807 days of antimicrobial therapy.
Conclusions
Patients hospitalized in community hospitals are rarely transferred for ID consultation. Our work demonstrates a need for ID consultation in community hospitals, identifying opportunities to enhance patient care by modifying antimicrobial regimens to improve antimicrobial stewardship and avoid inappropriate antimicrobials. Efforts to expand the ID workforce to include coverage at rural hospitals will likely improve antibiotic utilization.