Latest / The SHEA Podcast / Highlighting the Value of Antimicrobial Stewardship Programs during the Pandemic with IDSA

Transcript

Highlighting the Value of Antimicrobial Stewardship Programs during the Pandemic with IDSA · The SHEA Podcast

• 0:10
  SPEAKER_00: Welcome to the We're All in This Together COVID-19 Allies and Infection Prevention Podcast series as part of the Society for Healthcare Epidemiology of America Rapid Response Program.
• 0:21
  SPEAKER_00: I'm Dr.
• 0:22
  SPEAKER_00: Emily Spivak, Associate Professor of Medicine at the University of Utah School of Medicine, and I will serve as your SHA moderator and speaker.
• 0:30
  SPEAKER_00: I'm also happy to welcome Dr.
• 0:31
  SPEAKER_00: Pyle Patel, Assistant Professor at the University of Michigan, who will serve as your Infectious Diseases Society of America IDSA speaker for today's podcast.
• 0:40
  SPEAKER_00: Discussion on the podcast does not reflect SHA or IDSA's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:51
  SPEAKER_00: Today's episode will focus on issues around antimicrobial stewardship during COVID-19.
• 0:56
  SPEAKER_00: Let's get started with our first question.
• 0:58
  SPEAKER_00: Hi, Pyle.
• 0:59
  SPEAKER_01: Hey, it's great to talk to you.
• 1:00
  SPEAKER_00: You too.
• 1:02
  SPEAKER_00: So the first question I was going to ask you was how has your stewardship program changed during the last, what has it been, eight or so months during COVID-19?
• 1:11
  SPEAKER_01: I think all of our programs have seen a lot and it's been uh very flexible in terms of what things have been going on.
• 1:19
  SPEAKER_01: I'll say that when things started, much of our response at the VA was run through an incident command style leadership.
• 1:28
  SPEAKER_01: And so what ended up happening was we were kind of commanded under that to have a treatment protocol.
• 1:35
  SPEAKER_01: And so that involved the stewardship committee, but also some other people from the hospital that are familiar with the stewardship program, but maybe not necessarily always at our subcommittee meetings.
• 1:46
  SPEAKER_01: And that's kind of how we initially came up with our first treatment protocol.
• 1:50
  SPEAKER_01: But that was an ever-changing process.
• 1:52
  SPEAKER_01: And I'm sure for you it's been similar, you know, with this whole thing, we've kind of gone with the evidence as it comes in.
• 2:00
  SPEAKER_01: And that's been a really interesting way that our stewardship program has tried to stay up to date with the evidence and then change what we've been recommending, sometimes in what feels like a week-to-week basis.
• 2:12
  SPEAKER_01: I don't know if you felt the same way, Emily.
• 2:15
  SPEAKER_00: Yeah, I mean, our same here.
• 2:16
  SPEAKER_00: Our stewardship program got into COVID, I guess you'd say for the same reasons.
• 2:21
  SPEAKER_00: And it was my pharmacist really ahead of the game in January said, hey, there's novel coronavirus coming from China, and there's a lot out there and chatter about potential treatments.
• 2:31
  SPEAKER_00: And so, same thing.
• 2:32
  SPEAKER_00: We drafted essentially the initial guideline, which I've never updated one particular document so many times in such a short time span, similar to you, but essentially getting ahead of the game and leading any attempts around, really to be honest with you, putting guardrails around how people were potentially prescribing different drugs and not even just antimicrobials, but different drugs for COVID-19 gave us the opportunity to lead.
• 2:56
  SPEAKER_00: And then we by default then became sort of the go-to for any COVID-related questions, specifically therapeutic as well.
• 3:04
  SPEAKER_00: And then we, I'm sure similar to you, have different clinical trials that have come and gone.
• 3:09
  SPEAKER_00: And we've also then, in addition to the emergency use authorization from Desivir and now convalescent plasma, and where all of those different paths intersect is with stewardship and is with the guideline.
• 3:20
  SPEAKER_00: And so that has really given us an opportunity to make a lot of relationships.
• 3:25
  SPEAKER_00: And then for me to have to give updates every couple of weeks or every month now to this live stream that we have for all of the providers through hospital administration about therapeutics and our clinical trials and where things are going.
• 3:38
  SPEAKER_00: So it's like stuff that I would have never thought I would be doing and feels like a lot of work, but it's created a lot of bandwidth and opportunity for I think exposure for stewardship.
• 3:48
  SPEAKER_01: I totally agree.
• 3:49
  SPEAKER_01: I think it's interesting.
• 3:50
  SPEAKER_01: This podcast series is called We're All In This Together.
• 3:53
  SPEAKER_01: And I really felt that with our stewardship colleagues across the country, when all of this was happening and things were changing and evidence was changing really quickly, I know that I was kind of leaning on some of my stewardship colleagues to see, you know, when things were kind of new, like what are the treatment protocols at your hospital?
• 4:12
  SPEAKER_01: And we were sharing back and forth some of the work that we were looking at or the evidence.
• 4:16
  SPEAKER_01: And that has led to with a couple of colleagues, Mike Stevens out of VCU and Priya Nori from Albert Einstein Montefiore, we've kind of put out a couple of publications together just based off of that sharing that we were doing, thinking about how can stewardship programs play like a formal role, not just in this COVID-19 pandemic, you know, some of the structures that we have in place with all of our individual programs, I think really can help all of our healthcare institutions.
• 4:46
  SPEAKER_01: And I so I feel like that's really, I guess, a silver lining that's kind of coming out of this.
• 4:51
  SPEAKER_01: I don't know if you felt the same way.
• 4:54
  SPEAKER_00: Yeah, definitely.
• 4:55
  SPEAKER_00: I mean, I think clearly this has created, and it'll be smoother next time, but a roadmap for if and when this happens again, pulling stewardship in.
• 5:04
  SPEAKER_00: It'll be very obvious, I think, sort of what our role will be.
• 5:07
  SPEAKER_00: Again, kind of being the center piece or the cog and the wheel for okay, what's the intersection and who develops guidelines and how does that then dovetail clinical trials and then the emergency use.
• 5:17
  SPEAKER_00: Basically, our team every morning, we have a Zoom every morning at 9:30 where we review all COVID-positive patients as the stewardship team, and we're reviewing them for multiple purposes.
• 5:28
  SPEAKER_00: The original purpose is to review for who meets our criteria for emergency use remdesivir.
• 5:33
  SPEAKER_00: But then that dovetails with if we think they meet criteria, we then have to coordinate with the clinical trials to see okay, are you gonna approach and enroll this person because our remdesivir supplies come from different places, right?
• 5:44
  SPEAKER_00: There's the investigational drug pharmacy that has the trial remdesivir, and then there's a hospital supply.
• 5:49
  SPEAKER_00: And then at the time while we're there, we can look at antibiotics on all of these patients as well.
• 5:54
  SPEAKER_00: It's created a nice infrastructure to your point that I think if and when another pandemic happens, we've now bridged all these relationships with these different groups, and I think have a blueprint for how we would quickly roll this stuff out again.
• 6:08
  SPEAKER_00: It's been um busy, but I I think it's been uh quite rewarding.
• 6:12
  SPEAKER_00: I feel very satisfied with my job over the last few months.
• 6:15
  SPEAKER_01: Similar to that, we noticed, and I think now the evidence is kind of bearing out that early on in the pandemic, there was a lot of this kind of excess antibacterial use, possibly for like maybe covering secondary bacterial infections.
• 6:31
  SPEAKER_01: And our pharmacist and myself, we thought that this might be a good time to retool.
• 6:36
  SPEAKER_01: We had been talking about retooling our pneumonia stewardship guidelines, anyways.
• 6:40
  SPEAKER_01: And so we took this as an opportunity to kind of think about secondary bacterial infections and when should you think about that?
• 6:47
  SPEAKER_01: A diagnostic stewardship.
• 6:48
  SPEAKER_01: And so, in a way, COVID made us kind of bring that to the forefront.
• 6:52
  SPEAKER_01: And I think now there's more and more evidence from different parts of the US that are showing that we did probably overuse antibiotics and yet another role of the stewardship program during the COVID-19 pandemic, right?
• 7:05
  SPEAKER_00: Yeah, yeah.
• 7:06
  SPEAKER_00: And it's a nice opportunity again.
• 7:08
  SPEAKER_00: Sometimes you can kill two birds with one stone if you're looking at them for COVID to help with the COVID therapies.
• 7:13
  SPEAKER_00: There's somebody this morning I saw who is positive for COVID, seems to be quote unquote asymptomatic, but it's an elderly gentleman who's delirious and he got diagnosed with a UTI.
• 7:23
  SPEAKER_00: And I called him and I said, you know what?
• 7:24
  SPEAKER_00: We don't treat for altered mental status in a stable patient with bacteria anymore.
• 7:30
  SPEAKER_00: And hey, his mental status may just be from COVID.
• 7:32
  SPEAKER_00: So let's just hold the antibiotics and watch him.
• 7:35
  SPEAKER_00: And so that's like a nice intersection, I think, of traditional stewardship and COVID.
• 7:39
  SPEAKER_00: And another thing we've done, I think you and I have talked about this, is like stewardship was the obvious place at the University of Utah to, you know, the institution and pharmacy had interest, understandably, in figuring out, okay, how are we going to allocate our supply of Rimdesivir and some of these expensive medicines that are being investigated for COVID-19, but there's not evidence to use them?
• 8:00
  SPEAKER_00: Like, how do we sort of again put up guardrails or inform prescribing of those and kind of control it to a degree so that it doesn't get out of hand?
• 8:08
  SPEAKER_00: And our stewardship program has been the place where all of these drugs from the beginning have been restricted.
• 8:12
  SPEAKER_00: Hydroxychloroquine was restricted to us in uh rheumatology, the emergency use from desivere, there's essentially the stewardship physicians have to prescribe after we talk to teams about who meets criteria.
• 8:24
  SPEAKER_00: I mentioned to you the same thing is happening with convalescent plasma.
• 8:27
  SPEAKER_00: I've learned more about blood bank than I ever knew prior to this.
• 8:32
  SPEAKER_01: Because we have like some protocols in place where we're kind of used to doing this for different kinds of drugs.
• 8:38
  SPEAKER_01: Now you're taking that whole framework and shifting it over.
• 8:42
  SPEAKER_01: So, how are you guys doing that right now?
• 8:45
  SPEAKER_00: With all of these drugs, so you know, we have a guideline that basically says first put your patient into a clinical trial, you will be contacted if your patient meets eligibility.
• 8:52
  SPEAKER_00: And here's a link to the clinical trials.
• 8:54
  SPEAKER_00: And then we've, again, as we update it regularly, updated the COVID therapeutic guideline to really, you know, we took hydroxychloroquine off and put things on there for which there's evidence, just mimicking the NIH and IDSA guidelines.
• 9:07
  SPEAKER_00: But what we've been able to do is because we brought stakeholders in from the beginning, like the intensive care unit doctors, the hospitalists, the ER docs, et cetera, been able to really agree, and we've had to do it very rapidly as things moved on what the use criteria are for these different medicines.
• 9:24
  SPEAKER_00: And then pharmacy asked us, and because admin and pharmacy said, you know, we don't want to have anybody be able to write this because we need to keep track of our supplies.
• 9:34
  SPEAKER_00: Will you all manage the restrictions?
• 9:35
  SPEAKER_00: And I'm a yes ma'am, so I just said, yep, we'll figure it out.
• 9:39
  SPEAKER_00: We're used to doing this.
• 9:40
  SPEAKER_00: And they limited ordering to myself and to, you know, two other or three other physicians who help with stewardship now and COVID kind of stewardship.
• 9:49
  SPEAKER_00: And then the same thing happened with convalescent plasma.
• 9:52
  SPEAKER_00: It's only orderable by several of us.
• 9:53
  SPEAKER_00: And that was the blood bank's attempt at ARUP.
• 9:57
  SPEAKER_00: So to be honest with you, really key, so we don't get it, we get it from our own supply.
• 10:01
  SPEAKER_00: They collect from donors, but we have a limited supply of what they've collected, and what we have with them is high tide or convalescent plasma.
• 10:09
  SPEAKER_00: And it was an attempt for us to really control what we think is a good supply that we have.
• 10:13
  SPEAKER_00: And I have to tell you, people just kind of followed our lead.
• 10:17
  SPEAKER_00: I don't really have a great answer for that, other than I do think we had built before COVID a really strong face-to-face.
• 10:24
  SPEAKER_00: I'm a huge, if you want to call it handshake stewardship, I used to just call it face-to-face stewardship.
• 10:29
  SPEAKER_00: But like I'm a huge believer in FaceTime after having failed for several years when I first started stewardship here.
• 10:36
  SPEAKER_00: And I think those relationships that we built before COVID, it's kind of paying off now.
• 10:41
  SPEAKER_01: But I feel like, you know, that's a heavy lift.
• 10:44
  SPEAKER_01: I will say, like, that's something that I feel all of our stewardship programs are.
• 10:48
  SPEAKER_01: There's like the pros that we can bring to the game, but then when you have the same amount of resources, it's asking a lot, not just from stewardship MDs and farm Ds, but it's just spreading everyone really, really thin.
• 11:02
  unknown: Yeah.
• 11:02
  SPEAKER_01: So I feel like this is the time we're always talking about building the business case for ASP, right?
• 11:09
  SPEAKER_01: And I feel like we're really at all of our individual institutions kind of showing what we bring to the game.
• 11:15
  SPEAKER_01: And the more and more we take on, I do feel like it's hard.
• 11:19
  SPEAKER_01: I think, you know, you and I have talked about stewardship burnout before.
• 11:23
  SPEAKER_01: And um, I do worry that a lot of what we're we're doing at our individual programs could lead to burnout.
• 11:31
  SPEAKER_00: For sure.
• 11:32
  SPEAKER_00: Yeah, I think that was sort of bridges into the next question I was going to ask you, which is what are some of the frustrations or barriers to stewardship that you've experienced during this time?
• 11:42
  SPEAKER_00: And I think you're what you're getting at is sort of shifting priorities and spreading too thin.
• 11:47
  SPEAKER_01: Yeah, I think it's just a heavy lift because I think that many of us feel like we have to do what we normally do, right?
• 11:54
  SPEAKER_01: And that is trying to optimize antimicrobial use in the hospital, which is a full-time job.
• 12:01
  SPEAKER_01: And then on top of that, all of these new things that are coming with the pandemic.
• 12:05
  SPEAKER_01: That is staying up to date with the literature, the restrictions of new sorts of medicines and serum that we've kind of never done before.
• 12:14
  SPEAKER_01: And so that's a lot to do with when you have the same manpower and sometimes limited manpower, right?
• 12:20
  SPEAKER_01: Some people possibly aren't coming into the hospital as much.
• 12:24
  SPEAKER_01: And it's hard because I know for all of us, it's not easy to know that this is gonna end in three weeks.
• 12:30
  SPEAKER_01: So I think that's kind of been probably one of the tougher portions of this for me, I think.
• 12:36
  SPEAKER_01: What about for you?
• 12:37
  SPEAKER_00: Yeah, same.
• 12:38
  SPEAKER_00: I mean, to be honest with you, or just to be frank, I mean, we've I'll let's say we are not doing all the same day-to-day stewardship things that we were doing pre-COVID.
• 12:46
  SPEAKER_00: I mean, we are doing some of them, yes, but I don't think any of it's with the intensity of reviewing all positive bullet cultures, we're still doing, but I think the amount of individual patient prospective audit feedback based on the way we, you know, we've done it based on um different services and teams.
• 13:01
  SPEAKER_00: We just don't have the time to do all that because we've shifted to some of these other things.
• 13:05
  SPEAKER_00: I mean, are you able to maintain pre-COVID stewardship on top of what you're doing?
• 13:09
  SPEAKER_00: I mean, I think that's an honest conversation people probably need to have.
• 13:13
  SPEAKER_01: I agree.
• 13:14
  SPEAKER_01: And I want to shout out here to the ID Week Shea workshop that Emily, myself, and Jason Newland are putting together because we'll get an update not just on national activities and stewardship from Urgent Trini Vossen and the CDC to see what's going on with antibiotic use in the US, but also we are gonna have a session on stewardship burnout.
• 13:36
  SPEAKER_01: So if these topics are interesting to listeners, please join Emily, Jason, and I at the pre-ID Week workshop.
• 13:44
  SPEAKER_00: So get back to my question.
• 13:45
  SPEAKER_00: Have you been able to maintain sort of pre-COVID stewardship or workflow?
• 13:53
  SPEAKER_01: It's been really hard, but I would say it's, you know, a lot of that is our pharmacist, Steve Weisman, who does the brunt of a lot of this work during the day.
• 14:02
  SPEAKER_01: During his day, he does a lot of the antibiotic use, but he also does travel vaccinations and all of this other stuff.
• 14:08
  SPEAKER_01: So I think of that, the true antibiotic use has come to the forefront.
• 14:12
  SPEAKER_01: And hepatitis C treatment and some of those other things are lower on the list of things to get to.
• 14:19
  SPEAKER_01: I think it it's harder.
• 14:20
  SPEAKER_01: And I also believe that a lot of us are doing a lot of service time as well.
• 14:24
  SPEAKER_01: It's I wish that you know all we had to do was the stewardship, but it's hard when you're on consults and trying to also, you know, get to these stewardship Zoom meetings and so forth and weighing all of that together.
• 14:37
  SPEAKER_01: Yeah, I agree.
• 14:38
  SPEAKER_01: It's been really hard to figure out what to prioritize.
• 14:41
  SPEAKER_00: Yeah.
• 14:42
  SPEAKER_00: What's been a frustration for us and for our pharmacists as well, is that the pharmacists for the most part and the physicians, we all have our individual offices, luckily, at least for now, and have been able to come in if we needed to or work from home most days.
• 14:56
  SPEAKER_00: But we've actually been here for a lot of this, and the pharmacists have been asked to work from home.
• 15:01
  SPEAKER_00: They're coming back in a little bit more, but still predominantly working from home again because of shared offices and trying to minimize the number of people in the hospital and in the school medicine buildings.
• 15:12
  SPEAKER_00: And while I think there's obvious benefits to working at home personally and professionally, it's also, I think, been a little bit of a frustration and probably as far as non-COVID things goes, made our stewardship program be a little bit more behind the scenes and less visible, which has some downsides, right?
• 15:29
  SPEAKER_00: Um, we do again do a lot of sort of handshake stewardship and rounded with different medicine teams from varying days of the week, and we've had to stop all that.
• 15:37
  SPEAKER_00: So I worry people are like forgetting.
• 15:41
  SPEAKER_00: They hear from us for like through messages and we leave notes in the charts for high value or interventions, but we're a lot less visible, and I worry sort of about the long-term ramifications of that.
• 15:53
  SPEAKER_00: Yeah, that's so true.
• 15:54
  SPEAKER_01: Because I think, like you're saying, when you have a good thing going and you've already spent the time putting in the work to get what we refer to as this handshake stewardship, making sure that the teams know who the stewards are, have a good working relationship, can Skype them at any time, call them at any time about any questions.
• 16:14
  SPEAKER_01: When that becomes virtual, I think it's easier to kind of have that gap.
• 16:19
  SPEAKER_01: But imagine a new pharmacist or MDU.
• 16:22
  SPEAKER_01: This would be a really, really hard time to build that rapport.
• 16:25
  SPEAKER_00: Yeah, yeah.
• 16:26
  SPEAKER_00: And I think it highlights, you know, people, there's always been an interest in, I don't want to say automating stewardship, but what's the balance of decision support and sort of electronic communication versus face-to-face?
• 16:37
  SPEAKER_00: And I'm clearly highlighting that maybe I'm kind of old-fashioned, but I like the face-to-face stuff.
• 16:42
  SPEAKER_00: I do think this highlights some of the limits of you know, electronic sort of stewardship.
• 16:48
  SPEAKER_00: I totally agree with that.
• 16:50
  SPEAKER_01: Yeah, I totally agree with that.
• 16:52
  SPEAKER_00: So that's been frustrating.
• 16:53
  SPEAKER_00: And then also just I'm kind of a long game person, so I try and remind everybody everything we sort of started before this, and hey, we were developing a penicillin allergy delabeling protocol, and we meant to have this whole thing rolled out by now, and it's gonna take another five months.
• 17:07
  SPEAKER_00: It's frustrating to feel like you're not completing those things.
• 17:10
  SPEAKER_00: We'll get there eventually, but I can sense sort of team frustration of like, ugh, we're not really getting these things done, and also just team report.
• 17:19
  SPEAKER_00: I kind of miss seeing people.
• 17:21
  SPEAKER_01: Yeah, definitely.
• 17:22
  SPEAKER_01: You know, what happened to birthday parties and celebrations and anything with cake?
• 17:28
  SPEAKER_01: There's just like much less cake in the COVID era, I feel.
• 17:33
  SPEAKER_00: So, what has been to you some of the silver lining or benefits of this, if you if you will, that maybe you didn't anticipate?
• 17:40
  SPEAKER_01: One thing that I was thinking about was the infection control team, who, by the way, like our infection control colleagues, kind of to the extreme, all of the things that we're feeling, I know that they're feeling it even more.
• 17:54
  SPEAKER_01: But I feel like in general, the infection control colleagues have a common face-to-face with leadership, shows what they mean to the institution very often.
• 18:04
  SPEAKER_01: Whereas we don't get that opportunity as much.
• 18:07
  SPEAKER_01: But I think that actually this and during COVID, I think in most institutions, the stewardship committee this time has gotten some more of that showtime to show kind of why it's important to have a stewardship program, one that can do some of the things that we've all done during the pandemic.
• 18:24
  SPEAKER_01: So I would see that kind of as a silver lining for our stewardship program.
• 18:28
  SPEAKER_01: What about you?
• 18:29
  SPEAKER_00: Yeah, same stuff.
• 18:31
  SPEAKER_00: I mean, like I was saying, I have been asked from the beginning by the chief medical officer here to give, they happen to dip varying frequency and waned all off a little bit as this has gone on longer, but essentially giving regular updates to the physician group and it's all via live stream about COVID therapeutics, essentially.
• 18:49
  SPEAKER_00: They, I think, have such a clear idea, although it's COVID-related now, but anyway, about what it is that I do.
• 18:55
  SPEAKER_00: And I purposely put medical director antimicrobial stewardship on all those slides to prove to them to just make sure that there is all one piece to them and they see the value in what stewardship is.
• 19:06
  SPEAKER_00: And this, I think COVID has just been a great opportunity, and I'm blessed to have a good administration here that it is really highlighted in a very short time the value of the stewardship program.
• 19:17
  SPEAKER_00: And so I think I to be honest with you, I feel like I'm just banking capital for when this is over.
• 19:21
  SPEAKER_00: And I say to them regularly, I'm like, just so you know, we're gonna have a discussion when this is all over.
• 19:27
  SPEAKER_00: I'm sort of planting the seed that I want you all to realize that this is extra work that we're doing, and I want to talk about you know, more investment in pharmacist and physician FTE when clearly the finances.
• 19:38
  SPEAKER_00: I'm not pushing for it now because there's hiring freezes and all that, but they've been open to those discussions as I've gently sort of brought those up.
• 19:46
  SPEAKER_00: The other thing that we did is we created a whole separate pager, and it's kind of confusing, but it's called the COVID pager, and it's staffed by physicians, myself and two or three others.
• 19:56
  SPEAKER_00: And I I'm making the point to everybody, this is all stewardship to admin.
• 20:02
  SPEAKER_00: This is the same thing.
• 20:03
  SPEAKER_00: We are providing a service that is aside from seeing patients, and we were able to get some money for that pager.
• 20:09
  SPEAKER_00: We did it voluntarily at first because we saw the need for a pager for physicians, providers, inpatient that was separate from infection prevention questions that was around diagnosis and treatment and a way to funnel all these guidelines restrictions and stuff like that.
• 20:24
  SPEAKER_00: While we are feeling a little burned out, I am very glad that we have done it because we were able to get some money for it.
• 20:30
  SPEAKER_00: But it's also, again, highlighting the work that we can do, the value that a stewardship and ID physicians can bring and creating an opportunity, honestly, for me to argue for more stewardship FTE when all this is over.
• 20:44
  SPEAKER_01: That's awesome.
• 20:45
  SPEAKER_01: That's awesome.
• 20:45
  SPEAKER_01: I have to talk to you to you offline on how you did that because we're still staffing one for free.
• 20:51
  SPEAKER_00: Well, but my division chief helped.
• 20:54
  SPEAKER_00: So I think again, we can talk about it, but having some departmental divisional leadership.
• 20:58
  SPEAKER_00: And also I had a lot of great, we would have providers reach out to us and just say, thank you so much for helping me figure out how to get this person tested before surgery and for answering these questions.
• 21:09
  SPEAKER_00: And I asked them, I said, Do you mind sending a message to the CMO or can I forge your email to them to show that we're helping?
• 21:18
  SPEAKER_00: And I was pretty frank about that.
• 21:20
  SPEAKER_00: And having providers share their experience with the COVID pager to the administration, I think it's helped as well.
• 21:26
  SPEAKER_01: That's awesome.
• 21:27
  SPEAKER_00: That's the main silver lining for me is that this has been an awesome opportunity.
• 21:31
  SPEAKER_00: It's been a lot of work, but to expose the stewardship program.
• 21:34
  SPEAKER_00: I mean, I have relationships now with surgery because I was part of helping with the pre-op.
• 21:38
  SPEAKER_00: Essentially, we helped get surgery up and running with all the pre-op COVID testing.
• 21:43
  SPEAKER_00: And there was some essentially, we were the gatekeepers doing some diagnostic stewardship for some of the limited rapid testing capacity that we had for a pre-op.
• 21:50
  SPEAKER_00: The surgeons have really, really valued that, and that's created a whole opportunity to engage with them about traditional stewardship that's outside of COVID.
• 22:00
  SPEAKER_00: The relationship building through this has been amazing.
• 22:03
  SPEAKER_01: It's just kind of a Zoom virtual handshake stewardship that you're doing over there, Emily.
• 22:08
  SPEAKER_01: Love it.
• 22:09
  SPEAKER_01: The Zoom high five.
• 22:10
  SPEAKER_00: I'll give you a Zoom high five.
• 22:14
  SPEAKER_01: You've kind of outlined the value of stewardship programs during COVID.
• 22:19
  SPEAKER_01: And I think all of us, every steward in the US has similar kind of stories.
• 22:24
  SPEAKER_01: And so if there's any like leadership listening to this, think about the value that the stewardship program brings to individual institutions during a pandemic and during kind of regular days as well.
• 22:36
  SPEAKER_00: And I would encourage anybody, if you're doing good work, which I know you are for COVID via stewardship and you feel like people don't see it, find a way to highlight it because I think it will pay off in the long run.
• 22:49
  SPEAKER_00: And I think to your point, we're all doing really, really good work that is incredibly important for keeping all of this going during COVID.
• 22:57
  SPEAKER_00: And it needs to be recognized.
• 22:58
  SPEAKER_00: And I think it's a way to elevate stewardship in the future for the long term.
• 23:02
  SPEAKER_00: So awesome.
• 23:03
  SPEAKER_00: Well, thanks, Pile, and thank you everybody for joining us today.
• 23:06
  SPEAKER_00: And Pile, thank you for sharing your perspectives and experiences.
• 23:10
  SPEAKER_00: We'd also like to give a sincere thank you from Shay to all the healthcare personnel for all that you are doing to respond to COVID-19.
• 23:16
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 23:23
  SPEAKER_00: You will also find additional resources such as the recorded webinars, healthcare facility outbreak preparedness, and SHAY COVID-19 town halls, and the additional podcast series, COVID-19 update, what we know now, which is released every Thursday.
• 23:38
  SPEAKER_00: That concludes this episode of the Allies and Infection Prevention Podcast series.
• 23:42
  SPEAKER_00: Thanks for tuning in.
• 23:44
  SPEAKER_00: Thanks everyone.