In 2019, our multi-facility System identified reduction of Broad Spectrum Antibiotics utilization rates, reduction of hospital acquired Clostridioides difficile and increasing rate of conversion from intravenous to oral antibiotics as a priority. A multidisciplinary team used Lean Six Sigma methodology to identify opportunities for improvement. Two pilots were initiated, first where an alert was implemented in the electronic health record to prompt providers to consider antibiotic de-escalation. The second pilot modified pneumonia order sets to contain a pre-populated duration of therapy. Without additional costs, antibiotic utilization decreased by 24.4% and conversion to oral antimicrobials increased 9%.C.diff rates decreased by 76.9%.
Problem: Elevated antibiotic use, elevated rates of IV antibiotic use and higher than expected c.Diff rates were the problems we were trying to solve.
Measurement: As part of our discovery process, we use fishbone diagrams, control charts, and Failure Mode Effects Analysis.
Analysis: We used Lean Six Sigma and rates to quantify our analysis and findings.
Implementation: 1. An alert was piloted and implemented in the EHR to prompt providers to consider antibiotic de-escalation. 2. Pneumonia order sets were modified as a pilot with a pre-populated duration of therapy. 3. An alternative two-step process to test for C.diff was implemented. Keeping administration and providers informed was essential.
Results/Discussion: Without additional costs, antibiotic utilization decreased by 24.4% and conversion to oral antimicrobials increased 9%. The change in testing decreased C.diff rates by 76.9% and remains low. Utilization of Lean tool gave structure to our efforts, lending insight to contributing factors. Going to Gemba in the lab was critical.
