Implementing rapid diagnostic technologies (RDTs) into a health system can improve outcomes for patients and may be helpful in reducing unnecessary antibiotic use, according to data presented at the 2019 Annual American Society of Health-System Pharmacists Midyear Clinical Meeting & Exposition.
Katie Lusardi, PharmD and Clinical Pharmacist of Infectious Disease and Antimicrobial Stewardship at the University of Arkansas for Medical Sciences and Brandon Hill, PharmD and Clinical Pharmacist of Infectious Diseases at University of Virginia Health reviewed the multitude of RDT platforms available to practitioners and noted the role these technologies can play in collaborating with antimicrobial stewardship programs (ASPs).
Dr Lusardi noted that all platforms for RDT offer organism identification, while some also give markers for antibiotic resistance and susceptibility results. There are a wide variety of blood and respiratory RDT platforms available, she said, but RDT are only impactful when the data are available quickly, in conjunction with active interventions to help guide antibiotic decisions.
Making the Case for RDT Implementation
There are a number of benefits to RDTs, according to Dr Hill. He noted that high rates of hospital-acquired infections can lead to a lack of reimbursement from the Centers for Medicare and Medicaid Services (CMS), but showing how RDTs can impact patient care and the use of antimicrobials may convince the hospital “C suite” staff to invest in more of these technologies.
He suggested using publicly reported data available to patients on Medicare.gov to demonstrate to hospital administrators that RDTs can improve facility standings. Effective and timely care can improve sepsis recognition and management, he said.
As of March, hospitals are being asked by CMS to establish ASPs, and RDTs can help facilities gain traction in reducing unnecessary antibiotic use.
Dr Hill connected how using RDT can play a role in helping to fulfil the some of the CDC’s Core Elements of an ASP:
- Pharmacy Expertise: RDT helps clinical pharmacists streamline the process for identifying appropriate treatment options and ensuring those medications are administered in a timely manner.
- Actions: RDT helps with prospective audit and feedback and offers measurable outcomes.
- Tracking: RDT results can be used to monitor compliance with ASP recommendations and can provide a tangible outcome to be tracked following implementation.
- Reporting: ASPs can use RDT to facilitate communication with key stakeholders on outcomes, and results can show pharmacy activities and their impact.
- Education: Educating administrators and clinicians on RDT can improve acceptance when beginning a new initiative; providing RDT data to raise confidence in ASP and new technology.
Dr Hill noted that the Society of Infectious Disease Pharmacists (SIDP) have stated that “RDTs are 1 strategy for ASPs to achieve goals set forth by Joint Commission’s antimicrobial stewardship requirement in the acute care setting,” and the Infectious Disease Society of America (IDSA) has backed using RDTs as part of an ASP.
The most important outcomes of RDT are reducing inappropriate antimicrobial use and patient-specific outcomes such as mortality. Although the initial cost of setting up an RDT can be high, the cost pays off in effective implementation, Dr Hill added.
To persuade hospital leadership to embrace purchasing more RDT technologies, Dr Hill suggested enlisting an interdisciplinary group, incorporating goals and a vision for the health system, and highlighting previously published studies that show patient and institution specific benefits of RDT.
Although the literature are limited in showing that respiratory-focused RDTs decrease unnecessary antibiotic prescriptions for respiratory diseases, in some studies, RDT usage has been connected with a shortened time for patients to receive antivirals. More promising results are seen with RDTs for positive blood cultures. Several studies have shown reduced antimicrobial consumption, and time to effective therapy with RDT results are combined with active ASP interventions, when compared to RDTs alone or traditional laboratory methods.
Dr Hill urged attendees to prepare a detailed RDT proposal that predicts changes in outcomes of interest such as potential clinical and financial benefits. Implementation also should have regular updates on the impact of RDT in collaboration with an ASP based on pre-determined tracking and reporting methods. Finally, Dr Hill said that development of a structured algorithm for implementing RDT and ASP interventions are key in successfully implementing these strategies.
Lusardi K, Hill B. Rapid diagnostic technologies and antibiotic stewardship: better together [210-L01]. Presented at ASHP Midyear Clinical Meeting & Exposition. December 8, 2019. Las Vegas, Nevada.