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Impact of Patient Diagnoses and Provider Years of Practice on Antimicrobial Stewardship Program (ASP) Activities at a Non-freestanding Children’s Hospital

Abstract Background Baystate Children’s Hospital (BCH) is a non-freestanding children’s hospital with a recently implemented ASP. Patient populations of non-freestanding hospitals frequently differ from freestanding ones, with ASPs in the former often lacking. Our aim was to assess impact of patient diagnoses and primary provider years of practice on BCH ASP activities. Methods Chart review was performed for 1,170 antibiotic reviews from 808 patients evaluated by the ASP from 12/1/14 – 11/30/16 to determine seven clinical diagnostic categories and primary providers at the time of ASP review. We obtained provider years of practice via specialty board certification websites and years of BCH affiliation from credentialing records, with both grouped as <5, 5–15, or >15 years. Poisson regression was used to examine associations between diagnostic categories, years of practice and BCH affiliation, and likelihoods of ASP recommendation receipt and provider acceptance. Results Among 1,170 reviews, we found associations between recommendation receipt and both diagnostic category (highest probabilities were ENT/sinopulmonary = 55%; two distinct diagnoses = 57%) and provider years of practice (<5 years = 22%; 5–15 years = 37%; >15 years = 36%) (P < 0.01 for both). Of 414 recommendations received (307 [74%] of which were accepted), diagnostic category was associated with recommendation acceptance (highest acceptance rates: skin/soft-tissue infections = 99%, GI/genitourinary = 88%; lowest: two diagnoses = 62%) (P < 0.01). Regarding recommendations made to those with a BCH affiliation (n = 379), acceptance (n = 278 [73%]) was associated with years of affiliation (<5 years = 69%; 5–15 years =83%; >15 years = 63%) (P < 0.01). The association was not as strong across provider years of practice (<5 years = 68%; 5–15 years =79%; >15 years = 68%) (P = 0.08). Conclusion Patient clinical diagnostic categories and provider years of practice were significantly associated with ASP recommendation receipt and acceptance. Targeted educational efforts regarding ASP aims and activities may therefore benefit experienced primary providers and patients with certain clinical diagnoses at non-freestanding children’s hospitals without prior ASP exposure. Disclosures All authors: No reported disclosures.