Customer Stories at ASM Microbe:
Seven Keys to Success in Implementing Fast AST
At ASM Microbe 2019, we took a fresh approach: letting our customers speak for themselves. Conference attendees were able to interact with lab professionals, pharmacists, and clinicians who use the Accelerate Pheno™ system at two Industry Showcases, two “Real Talks” hosted in our exhibit booth, and two Customer Panel Dinners. Customers featured at these events came from a variety of large and small hospitals in urban and rural settings.
Discussion in the sessions centered on the process of implementing the Accelerate Pheno™ system and how the system is impacting patient outcomes, antibiotic stewardship, and hospital economics in their institutions. Here are seven keys to success our customers voiced at ASM Microbe 2019.
- Bring everyone together early.
In each session, customers repeatedly emphasized the importance of gathering key stakeholders from the micro lab, stewardship, ID/physician, quality, IT, and executive teams early in the decision-making process. The earlier customers articulated the purpose and value of implementing fast phenotypic susceptibilities to all stakeholders, the sooner their colleagues got behind the effort, which led to a smoother and faster implementation process. Bringing stakeholders together early is especially useful in overcoming resistance or inertia, and in agreeing on how to prioritize resources like IT.
- Be ready to articulate how phenotypic antibiotic susceptibility testing is better.
At Saturday’s Industry Showcase, Rodger Silletti (Director of Clinical Microbiology at NYU Winthrop) provided a thought-provoking seminar on the relative utility of genotypic and phenotypic testing for providing actionable diagnostic results that improve outcomes. Dr. Silletti identified the diverse molecular determinants of resistance that can, and cannot, be detected with commercially available, IVD-cleared molecular rapid diagnostic tests (MRTs). These include many hosts of ESBL, CTX-M variants, and single nucleotide mutations that may reduce MRT sensitivity or specificity. “Molecular testing can’t elucidate resistance mechanisms, so I can’t tell you whether the organism is sensitive or not,” Dr. Silletti said, concluding that “molecular resistance testing, as a rapid methodology, has a place in assessing empiric therapy for specific organisms and specific drugs. Phenotypic susceptibility testing, as a rapid methodology, has a place in empiric therapy and continuing management for most organisms and for most drugs.
- When developing the business justification: undersell and overdeliver.
At Friday’s Customer Panel Dinner, one customer described how setting conservative and achievable goals enabled his team to justify implementing the Accelerate Pheno™ system to administrators at his hospital. He noted that he used an ROI tool developed by AXDX and then reduced the assumptions in it to undersell and overdeliver. He reported that use of the system is already exceeding expectations.Other customers echoed those sentiments during the conference and suggested using variables such as measurable conservation of empiric antibiotics, reductions in cases of acute kidney injury and C. difficile, or a modest decrease in hospital LOS to set goals for return on investment of the Accelerate Pheno™ system.
- Faster targeted therapy reduces use of empirics and supports stewardship.
At Friday’s Industry Showcase, Micah Bhatti (Technical Director of Microbiology at MD Anderson Cancer Center) and Aaron Glatt (Chief of Infectious Diseases and Head of Antimicrobial Stewardship at South Nassau Communities Hospital South Nassau Communities Hospital) said their institutions have seen a reduction in use of broad-spectrum therapy; and two other customers reported the same reductions in the Customer Panel Dinners. Drs. Glatt and Bhatti shared a total of five patient cases in which therapy was optimized at least 24 hours sooner than it would otherwise have been, saving at least one full day per case in empiric use. At Saturday’s Industry Showcase, Michael Miller and Sahil Sheth (head of antimicrobial stewardship and critical care pharmacist, respectively, at Peninsula Regional Medical Center) reported median days on broad-spectrum antibiotic therapy has dropped from 3 days to 1 day per patient with Gram-negative bacteremia.
- Acting on fast phenotypic susceptibilities can reduce cost and length of stay.
Multiple customers reported reductions in length of stay (LOS) in patients tested on the Accelerate Pheno™ system vs. previous methods. At Saturday’s Industry Showcase, Drs. Miller and Sheth (Peninsula Regional Medical Center) shared a presentation of the improvements in patient outcomes and cost of sepsis care seen since implementing the Accelerate PhenoTest™ BC kit for patients with Gram-negative bacteremia. These included a statistically significant 2-day reduction in hospital length of stay, and compelling data were shared indicating an estimate of $150k to $250k reduction in the cost of sepsis care since implementation of the Accelerate PhenoTest™ BC kit.In the Friday Industry Showcase, Dr. Glatt (South Nassau) noted that his institution has seen reductions in hospital length of stay for patients tested on the Accelerate Pheno™ system; in the Customer Panel Dinners, three other customers said they also were seeing shorter hospital lengths of stay.
- Faster susceptibilities can prompt improvements in workflow and clinical pathways.
Margie Morgan (Scientific Director of Microbiology at Cedars-Sinai) noted that the early involvement of her hospital’s antibiotic stewardship team enabled them to work together with clinicians to develop a clear workflow and protocol for reporting results from the Accelerate PhenoTest™ BC kit. “Our stewardship pharmacist has thanked us [because] the intervention they have with an MIC is so much easier than intervention they had when we used resistance markers.”And in the Friday Industry Showcase, Dr. Bhatti (MD Anderson Cancer Center) highlighted that with their previous method, results would reach clinicians 1–2 days after positive blood culture. “At that point, it’s hard to get them to change therapy if it’s working. Now we get results to them in seven hours, and they’re a lot less reluctant to change therapy.” Dr. Glatt (South Nassau Communities Hospital) described how, in addition to implementing the Accelerate Pheno™ system for faster susceptibilities, his hospital has undertaken a host of initiatives to improve stewardship workflow, including dispatching multiple ID pharmacists to both daily rounds and monthly grand rounds, enhancing education for non-ID pharmacists, and initiating a clinical pharmacy residency.Peninsula Regional Medical Center also noted that their institution did not have 24/7 stewardship initially, but that with the implementation of the Accelerate Pheno™ system, they have also implemented 24-hour stewardship on weekdays.
- Customer service is critical.
Customers consistently cited their support team as vital to the success of their implementation. At the Customer Panel Dinners, one customer related how an ID pharmacist on the AXDX clinical implementation support team helped her hospital develop new stewardship guidelines. Other customers discussed how helpful the AXDX team members were with developing the business justification and managing the logistics of the implementation process.
Learn more about the Accelerate Pheno™ system
Industry & Science Showcase South
Presented by: Micah M. Bhatti, MD, PhD
Technical Director, Clinical Microbiology Laboratory
University of Texas, MD Anderson Cancer Center
Presented by: Aaron Glatt, MD, FACP, FIDSA, FSHEA
Chairman, Department of Medicine
Chief, Infectious Diseases & Hospital Epidemiologist
South Nassau Communities Hospital
Clinical Professor of Medicine
Icahn School of Medicine at Mount Sinai
Implementing Fast Phenotypic Antibiotic Susceptibilities: The Community Hospital Experience
Industry & Science Showcase South
Presented by: Rodger Silletti, PhD, D(ABMM)
Director of Microbiology
NYU Winthrop Hospital
Presented by: Michael Miller, PharmD, BCPS
Peninsula Regional Medical Center
Presented by: Sahil Sheth, PharmD
Critical Care Pharmacy Specialist
Peninsula Regional Medical Center