Application of Standardized Antimicrobial Administration Ratio as a Motivational Tool within a Multi-Hospital Healthcare System

• Main Authors: Stephanie Shealy, Joseph Kohn, Emily Yongue, Casey Troficanto, P. Brandon Bookstaver, Julie Ann Justo, Hana R. Winders, Sangita Dash, Majdi N. Al-Hasan
• Format: Article
• Language: English
• Published: MDPI AG 2021-02-01
• Series: Pharmacy
• Subjects: antibiotics; antimicrobial use; antimicrobial stewardship; metrics
• Online Access: https://www.mdpi.com/2226-4787/9/1/32

The standardized antimicrobial administration ratio (SAAR) is a novel antimicrobial stewardship metric that compares actual to expected antimicrobial use (AU). This prospective cohort study examines the utility of SAAR reporting and inter-facility comparisons as a motivational tool to improve overall and broad-spectrum AU within a three-hospital healthcare system. Transparent inter-facility comparisons were deployed during system-wide antimicrobial stewardship meetings beginning in October 2017. Stakeholders were advised to interpret the results to foster competition and incorporate SAAR data into focused antimicrobial stewardship interventions. Student’s <i>t</i>-test was used to compare mean SAARs in the pre- (July 2017 through October 2017) and post-intervention periods (November 2017 through June 2019). The mean pre-intervention SAARs for hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Hospital B experienced significant reductions in SAAR for overall AU (from 1.09 to 0.83; <i>p</i> < 0.001), broad-spectrum antimicrobials used for hospital-onset infections (from 1.36 to 0.81; <i>p</i> < 0.001), and agents used for resistant gram-positive infections in the intensive care units (from 1.27 to 0.72; <i>p</i> < 0.001) after the interventions. The alignment of the SAAR across the health-system and sustained reduction in overall and broad-spectrum AU through implementation of inter-facility comparisons demonstrate the utility in the motivational application of this antimicrobial use metric.