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Cojutti PG, Gatti M, Bonifazi F, Caramelli F, Castelli A, Cavo M, Cescon M, Corvaglia LT, Lanari M, Marinelli S, Morelli MC, Pession A, Poggioli G, Ramirez S, Siniscalchi A, Tonetti T, Trevisani F, Zanoni A, Zinzani PL, Gibertoni C, Viale P, Pea F. Impact of a newly established expert clinical pharmacological advice program based on TDM results in tailoring antimicrobial therapies hospital-wide in a tertiary university hospital: findings after the first-year of implementation. Int J Antimicrob Agents 2023:106884. [PMID: 37302773 DOI: 10.1016/j.ijantimicag.2023.106884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) may be helpful in tailoring treatment with antimicrobials, and expert interpretation of the results may make it more clinically useful. METHOD The study aim was to assess retrospectively the first-year impact (July 2021-June 2022) of a newly established expert clinical pharmacological advice program (ECPA) based on TDM results in tailoring therapy with 18 antimicrobials hospital-wide in a tertiary university hospital. All patients having ≥1 ECPA were grouped in five cohorts [hematology, intensive care unit (ICU), pediatrics, medical- and surgical- wards]. Four indicators of performance were identified [total ECPAs; total ECPA recommending dosing adjustments/total ECPAs both at first and at subsequent assessments; turnaround time (TAT) of ECPAs, defined as optimal (<12h), quasi-optimal (12-24h), acceptable (24-48h), suboptimal (>48h)]. RESULTS A total of 8484 ECPAs were provided for tailoring treatment in 2961 patients, mostly admitted in the ICU (33.8%) and in the medical wards (29.4%). The proportions of ECPAs recommending dosing adjustments were >40% at first assessment (40.9% in hematology; 62.8% in ICU; 53.9% in pediatrics; 59.1% in medical wards; 59.7% in surgical wards), and decreased consistently at subsequent TDM assessments (20.7% in hematology; 40.6% in ICU; 37.4% in pediatrics; 32.9% in medical wards; 29.2% in surgical wards). The overall median TAT of the ECPAs was optimal (8.11h). CONCLUSIONS The TDM-guided ECPA program was successful in tailoring treatment with a wide panel of antimicrobials hospital-wide. Expert interpretation by MD clinical pharmacologists, short TATs and strict interaction with ID consultants and clinicians were crucial in attaining this.
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Affiliation(s)
- Pier Giorgio Cojutti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Francesca Bonifazi
- Institute of Hematology "L. and A. Seràgnoli", IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Castelli
- Anaesthesiology and Intensive Care, Cardiothoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Cavo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Institute of Hematology "L. and A. Seràgnoli", IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Liver Transplant Center, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Tommaso Corvaglia
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Neonatal Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sara Marinelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Cristina Morelli
- Internal Medicine Unit for the treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Pediatric Oncology & Hematology Unit 'Lalla Seràgnoli', IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gilberto Poggioli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Antonio Siniscalchi
- Division of Anesthesiology, Department of Anesthesia and Intensive Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tommaso Tonetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Anesthesiology and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Zanoni
- Division of Anesthesiology, Department of Anesthesia and Intensive Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Institute of Hematology "L. and A. Seràgnoli", IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Chiara Gibertoni
- Hospital Directorate, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
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Gorla F, Borojevic A, Gibertoni C, Landi L, Storchi M, Fontana L, Regmi J, Burmen B, Silenzi A. The Hospital of Tomorrow Case Study: Multidisciplinarity, Inclusiveness and Holistic Approaches to Foster Innovation in Complex Organizations. Int J Health Policy Manag 2023; 12:7330. [PMID: 37579430 PMCID: PMC10125057 DOI: 10.34172/ijhpm.2023.7330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 01/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND This case study describes and analyses an action research initiative undertaken by management, staff and WHO at the St. Orsola-Malpighi Polyclinic in Bologna, Italy. The initiative utilised staff engagement approaches developed during the COVID-19 pandemic to rethink and reshape future development plans. The initiative provides a 'how-to' case study for complex health facilities on ways to create similar multisectoral, inclusive and holistic processes in planning structural, functional and organizational solutions for their 'hospitals of tomorrow'. METHODS The case study utilised an action research approach coordinated by a team of WHO facilitators in close collaboration with the Board of Hospital Directors. Heterogeneous and multidisciplinary working groups were created, with members from different levels of the hospital staff. In the context of facilitated group meetings held weekly over a one-year period, participants were asked to review topics of interest to future plans of the hospital and make recommendations on effective/innovative ways of addressing these in the short and long term. Working groups focused on different challenges. RESULTS The initiative was successful in creating and sustaining broad staff engagement in the future planning processes. 80% groups maintained high staff participation throughout the entire project year. Participating staff reported enhanced communication and cooperation between departments represented in different groups. 87% of the proposed plans suggested by the working groups were approved by the Board for implementation. CONCLUSION Key factors contributing to the high approval rate of plans, strong engagement record of staff and enhanced cooperation between involved departments; included: multisectoral/cross hierarchal staff involvement, group attention to defining time-bound contextual goals, flexible implementation monitoring approaches, personnel skills and profiles of participants, direct and open communication at all levels and times, member commitment and clear exit strategy. The case study is presented as a model to stimulate similar actions in other complex health care facilities.
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Affiliation(s)
- Francesca Gorla
- World Health Organization, Headquarters, Geneva, Switzerland
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Anja Borojevic
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
- James Lind Institute, Geneva, Switzerland
| | - Chiara Gibertoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Lorena Landi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Marco Storchi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Luca Fontana
- World Health Organization, Headquarters, Geneva, Switzerland
| | - Jetri Regmi
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Barbara Burmen
- World Health Organization, Headquarters, Geneva, Switzerland
| | - Anna Silenzi
- World Health Organization, Headquarters, Geneva, Switzerland
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Viale P, Tumietto F, Giannella M, Bartoletti M, Tedeschi S, Ambretti S, Cristini F, Gibertoni C, Venturi S, Cavalli M, De Palma A, Puggioli M, Mosci D, Callea E, Masina R, Moro M, Lewis R. Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy. Clin Microbiol Infect 2015; 21:242-7. [DOI: 10.1016/j.cmi.2014.10.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/29/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
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