We’ve come a long way in understanding the role that bacteria play in our lives and health. Once, a minor cut could become fatal if infected. Today, powerful antibiotics target bacteria and often eliminate these risks – but too much of a good thing has caused new problems. Bacteria adapt and evolve in order to resist the effects of antibiotics, and these new strains of antibiotic-resistant “superbugs” are causing serious, even deadly, outbreaks around the world.
We won’t solve this problem with the same tools that caused it. Ochsner is reducing its rates of antibiotic prescribing – and finding ways to limit the spread of certain bacterial infections without the use of drugs. These innovative approaches could provide a model for other health systems to reduce infections and antibiotic use as this problem grows.
Multidrug-resistant organisms cause more than 2 million illnesses and at least 23,000 deaths in the U.S. alone. And doctors may be making the problem worse: up to 50% of antibiotics in the U.S. are inappropriately prescribed, meaning that physicians are writing prescriptions to treat conditions like the flu virus, which antibiotics do not help. In 2015, the White House released the National Action Plan for Combating Antibiotic-Resistant Bacteria, calling for a 50% reduction in inappropriate antibiotic prescriptions by 2020. Ochsner responded to this call to action with a number of initiatives that changed prescribing behavior across our system.
First, we educated providers on the facts related to antibiotic overprescribing and resistance. We provided educational posters created by the CDC that doctors could place in waiting rooms and exam rooms, designed to inform patients that antibiotics are ineffective for cold and flu symptoms – thereby reducing pressure on doctors to prescribe. Finally, we distributed “report cards” showing each physician’s rate of inappropriate prescribing in comparison to their peers. The interventions worked: after two years, one group of physicians tested reduced inappropriate prescribing from 52% to just 16%.
Clostridioides difficile, or C. diff, is a bacterium that causes gastrointestinal illness. It can be dangerous and even deadly for those with compromised immune systems, which is why it’s essential to keep this bug away from hospital patients.
Rather than waiting to react if and when C. diff infections occur, members of Ochsner’s innovation team wanted to find a way to determine which patients would be most likely to contract C. diff – and intervene before an infection happened. The team used an artificial intelligence-based approach that had been used successfully to solve other challenges, including identifying hospital patients at risk for cardiac arrest. Using information contained in the Epic electronic heal th record system, the team was able to process large amounts of complex data and make more accurate predictions than care teams could on their own. Patients identified as being at-risk were put on a preventive program. After eight months of piloting this approach, Ochsner’s rate of C. diff infection decreased by more than 35%.