November 21, 2011
The Institute for Healthcare Improvement (IHI) has announced the launch of a pilot testing program designed to avoid overuse and misuse of antibiotics in hospitals. Designed in collaboration with the Centers for Disease Control and Prevention (CDC), the program focuses on a new jointly developed initiative, the CDC/IHI Driver Diagram and Change Package for Antibiotic Stewardship. Centerpoint Medical Center is one of eight hospitals across the country selected to participate in the pilot program.
Antibiotics are the most powerful tool in combating life-threatening bacterial diseases, yet their effectiveness is compromised when they are used inappropriately. Overuse and misuse contribute both to antibiotic resistance, one of the world’s most pressing public health threats, and to a decrease in the stocks of these vital resources. It is estimated that at least 50 percent of antibiotic use in U.S. hospitals is inappropriate.
One of the challenges to improving antibiotic use in hospitals is the lack of well-organized and implemented blueprints for how to accomplish this complex task. The Driver Diagram and Change Package meet this need by using an established method for improving care in hospitals. A driver diagram is a tool to help organize theories and ideas about the changes an organization can make to improve outcomes. A change package provides change ideas for each of the drivers associated with the overall aim or outcome.
“The Driver Diagram and Change Package framework has been used effectively to improve a variety of processes and outcomes in hospitals,” said Donald Goldmann, Senior Vice President at IHI, infectious diseases specialist and Professor of Pediatrics at Harvard Medical School. “I have personal experience with the many barriers to improving antibiotic use in hospitals. Although it’s a complex challenge, I’m optimistic that the development, refinement and implementation of this Driver Diagram and Change Package will be important steps to broader improvements in antibiotic use in hospitals.”
Jointly developed by CDC and IHI with guidance and input from a variety of experts, the Driver Diagram and Change Package lay out a number of practical steps that hospitals can follow. Ultimately, the Diagram and the Package will seek to embed the fundamental changes required for antibiotic stewardship in the system of care, especially at the front line.
“We are looking forward to working with IHI and the pilot hospitals to help develop a practical action plan that all hospitals will be able to utilize to improve antibiotic use,” said Arjun Srinivasan, Medical Director of CDC’s Get Smart for Healthcare program, which aims to improve antibiotic use in hospitals.
Eight hospitals in eight states were selected to serve as the testing sites. In selecting them, CDC and IHI looked to engage hospitals of different sizes, areas of expertise, and geographic locations that were willing to test the program across a variety of conditions. The sites include:
- Community Hospital, Tallassee, AL;
- Centerpoint Medical Center, Independence, MO;
- Rogue Valley Medical Center, Medford, OR;
- St. Francis Medical Center, Peoria, IL;
- Seton Medical Center, Austin, TX;
- The Reading Hospital and Medical Center, West Reading, PA;
- Ronald Reagan UCLA Medical Center, Los Angeles, CA;
- WellStar Cobb Hospital, Austell, GA.
“This project is especially exciting in that it brings together the public health experience of CDC and the implementation and health care improvement experience of IHI,” said Dr. Edward Septimus, Medical Director of Infection Prevention and Epidemiology for the Hospital Corporation of America (HCA), who will serve as the faculty lead for the testing project. “We know improvements in antibiotic use can be made, and this project will help us better understand how to make them in a variety of different hospital settings.”
Dr. Christopher Sullivan, Chief Medical Officer for Centerpoint Medical Center, said it’s an honor to have the hospital participate in this pilot study and eventually be recognized nationally. “ Centerpoint Medical Center has an exceptional staff committed to this project and we look forward to collaborating with colleagues across the county,” he said.
Dr. Scott Flanders, Professor of Medicine at the University of Michigan and past president of the Society of Hospital Medicine, the largest organization representing hospitalists, will also serve as faculty of the pilot program.
“Increasingly, hospitalists are on the front line of care in U.S. hospitals,” said Dr. Flanders. “They are well-positioned to contribute to this pilot project and have a longstanding commitment to improving health care quality.”