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The findings can help hospitals successfully implement an antibiotic stewardship program that is designed to prevent antibiotic overuse by reviewing prescriptions and making recommendations as patients prepare to leave the hospital. Five factors, both operational and human, were found to play important roles in the implementation of the antibiotic stewardship program:

1. Strong relationships and communication between the program team and prescribing physicians
2. Physicians’ trust in the team, which improves acceptance of recommendations
3. Robust workflows and hospital systems, such as discharge planning meetings
4. Existing antibiotic review processes
5. Clear documentation of upcoming discharges

Study purpose and design

Antibiotic prescribing is monitored far less frequently at discharge than during inpatient care, Jones said. This can lead to unnecessary antibiotic use, thereby increasing the risk of antibiotic resistance and making infections harder to treat.

“Discharge is a critical gap in antibiotic stewardship, as a large proportion of total antibiotic exposure occurs after patients leave the hospital,” she said. “Research has also shown higher rates of inappropriate prescribing at this transition, including incorrect dosing, selection, and duration.”

Researchers interviewed 14 staff members at 10 hospitals across the U.S. that had implemented the program at their institutions. These included three Veteran Health Administration hospitals, two academic medical centers, and five community hospitals. The staff were asked about their perceptions of how the implementation process went.

“When implementing an antibiotic stewardship program across multiple sites, it is essential to understand each site’s unique context to ensure effective implementation and evaluation,” said Jones. “This includes considering how antimicrobial stewardship teams have historically collaborated with providers, as well as identifying existing systems and workflows that may support or impede the adoption of the intervention.”

Knowing when a patient is discharged is critical to implementation

Within 48 hours of a patient’s discharge, a team of infectious disease experts and pharmacists reviews the patient’s antibiotic plan. They recommended changes to the prescribing physician, who can either maintain or adjust the prescription, if they have concerns.

Hospital teams reported that the unpredictability of when a patient will be discharged and the lack of discharge documentation in workflows were significant barriers to implementing the program. At half of the hospitals, teams struggled to identify discharged patients.

“Hospitals that found this easier had stronger communication systems in place, like messaging tools or stewardship teams that regularly worked with providers,” said Jones. “This suggests that scaling the program nationally will require flexible systems and workflows that support real-time communication and coordination.”

The study noted that researchers should develop and test reliable ways to identify patients who are close to discharge, so that discharge-related antibiotic review and feedback can be built into everyday clinical workflows.

The study, “Qualitative Assessment of Antibiotic Stewardship Teams’ Efforts to Perform Prospective Audit-and-Feedback at Hospital Discharge,” was published in Antimicrobial Stewardship Healthcare Epidemiology. Additional authors include Daniel Livorsi, associate professor in the Department of Internal Medicine, and two ICTS researchers: Emily Chasco, assistant research scientist and Cody Poe, former clinical trials research associate.

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