6 Principles from Antimicrobial Stewardship Programs that can be Applied to Enhance the Effectiveness of Inpatient Consults in Behavioral Health
6 Principles from Antimicrobial Stewardship Programs that can be Applied to Enhance the Effectiveness of Inpatient Consults in Behavioral Health
Antimicrobial stewardship programs (ASP) started to emerge in the 1990s when growing concerns about the threat of antimicrobial resistance gained traction. In the early 2000s, mostly in the US and Europe, more formal antimicrobial stewardship programs started to develop. In 2017, the Joint Commission implemented new antimicrobial stewardship standards as part of their accreditation process for hospitals, critical access hospitals, and nursing care centers. The primary objective for ASP is to improve patient outcomes, reduce the development and spread of antimicrobial resistance, and preserve the effectiveness of existing antimicrobial medications.
To intervene ASP providers must consistently review all patients who have an antimicrobial prescribed and determine if the medication is appropriate. If deemed inappropriate, ASP providers will often reach out, in an unsolicited manner, to the primary treatment team. During these calls the reason for the ASP call, questions on the diagnoses for patient, and selection and dosing of antimicrobials are all reviewed. While many of the calls are professional, and the ASP resources are considered by many prescribers to be helpful, offering unsolicited treatment to providers is not always a welcome phone call.
In the same way ASP is being proactive and reaching out to providers regarding antimicrobials, behavioral health providers need to do the same. Current practice for many providers is to wait for consult requests. However, there are patients that can and will benefit from a consultation with a behavioral health specialist. The behavioral health and addiction medicine community can gain several valuable lessons when it comes to providing unsolicited inpatient consultations.
While the fields are quite different, there are key principles from ASP that can be applied to enhance the effectiveness of inpatient consults in behavioral health and addiction medicine:
1. Collaboration and communication: Just as ASP involves a multidisciplinary team, behavioral health consultations can benefit from collaboration between various healthcare professionals, including physicians, nurses, pharmacists, and social workers. Effective communication and cooperation among team members can lead to better patient outcomes and transition of care.
2. Evidence-based interventions: ASP relies on evidence-based interventions to optimize antimicrobial use. Similarly, inpatient consultations in behavioral health and addiction medicine should be grounded in evidence-based practices to ensure that patients receive the most effective and appropriate care. More research needs to be conducted on effective methods to screen for behavioral health diagnoses in the acute care setting, but many healthcare facilities are implementing hospital wide depression and suicide screening. Using electronic reports, behavioral health providers can actively monitor depression scores, and prioritize intervention in those with highest chance for having behavioral health diagnoses.
3. Monitoring and feedback: ASP routinely monitors and evaluates the impact of their interventions. In the context of behavioral health and addiction medicine, ongoing assessment and feedback can help identify areas for improvement, measure progress, and adjust strategies as needed. Like ASP, inpatient behavioral health consultants can analyze the impact their programs have on key drivers of mortality, length of stay, readmission, and cost. With an increase of opioid and behavioral health related admissions to EDs and urgent care centers, many healthcare organizations are beginning to see the value in investing in behavioral health treatment early in the care process.
4. Education and awareness: A key component of antimicrobial stewardship is promoting awareness and education about appropriate antimicrobial use. Behavioral health and addiction medicine professionals can similarly educate patients, families, and other healthcare providers on relevant topics, such as the importance of mental health, evidence-based treatments, and the risks of substance use disorders. Many academic medical centers have a resident and trainee introduction fair or some gathering similar. Often you will see ASP and infection control at these groups, introducing their program to new providers and supplying them with resources that will help them more effectively treat patients. While it is time consuming, investing in outreach to your provider base is key.
5. Patient-centered care: ASP prioritizes the needs of the patient in the decision-making process. In behavioral health, it is crucial to provide individualized care that considers each patient's unique circumstances, preferences, and goals. Behavioral health, and addiction medicine, has not limited infrastructure for tracking patient outcomes but there is a growing consensus that taking a holistic perspective to patient care is essential to reaching people in need of care.
6. Resource optimization: ASP seeks to optimize the use of available resources while minimizing unnecessary interventions. ASP providers have found innovative ways of trying the ASP performance to resources. Similarly, behavioral health and addiction medicine professionals should find ways to track and link patient care to resource utilization.
While ASP and behavioral health are far different in their backgrounds, they both have similar goals. ASP wants to identify the proper use of antimicrobials so these medications can be preserved, and patients don’t receive unnecessary harm. Behavioral health has ambitions of intervening while patients are in the hospital, linking the patient to outpatient treatment, and offering medication options if needed, to ensure patients don’t receive unnecessary harm. By applying these principles from ASP, behavioral health and addiction medicine professionals can enhance the quality of care provided during unsolicited inpatient consultations, ultimately leading to better patient outcomes.