TREAT Steward. Antimicrobial Stewardship software with personalized decision support

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1 TREAT Steward TM Antimicrobial Stewardship software with personalized decision support

2 ANTIMICROBIAL STEWARDSHIP - Interdisciplinary actions to improve patient care Quality Assurance The aim of antimicrobial stewardship initiatives is to improve the safe and appropriate use of antimicrobials, reduce patient harm and decrease the incidence of antimicrobial resistance essentially quality assurance. TREAT Steward provides the infectious disease specialist with tools for monitoring and correcting antimicrobial treatments across departments and for making antimicrobial guidelines accessible at point of care. Decision Support The unique functionality of TREAT Steward is its decision support modules. TREAT Steward provides clinicians with information during the patient encounter to facilitate accurate diagnosis and treatment. On average, TREAT Steward reduces the prescription of non-covering antimicrobials by 15% while reducing the usage of broad-spectrum antimicrobials. Statistics and Surveillance TREAT Steward provides excellent tools for tracking and monitoring antimicrobial prescriptions, clinical performance and resistance patterns. The statistical modules can be used to generate regular reports at a management- and specialist level. An important feature is the provision of educational functionalities for individual training of doctors. Infection Journal Inspection Tool Textual Guideline Worklist QUALITY ASSURANCE Risk Assessment? TREAT STEWARD Steward TM i TM DECISION SUPPORT STATISTICS AND SURVEILLANCE Reporting Tool Intelligent Advice Dosing Assistant Personalized Antibiogram My Patients

3 SUPPORTING THE CLINICAL WORKFLOW - TREAT Steward is fully integrated with the EHR* and other hospital systems Workflow Activated from within the EHR*, TREAT Steward requires only minimal data entry before providing a summary of all infection-related information and recommended treatments. Following the clinician s choice of treatment, an infection note is generated and written back to the EHR, closing the loop. The user is then automatically redirected to the hospital s prescription module, where their choice of drug has been prefilled. Activate from EHR Collection Collection of of data information Summary and treatment Infection Infection note note and Send information and restricted code code to EHR Activate from EHR Infection note stored in EHR Hospital prescription module prefilled with generic antimicrobial *EHR: TREAT Electronic is fully integrated Health Record. TREAT automatically TREAT automatically A structured free text TREAT automatically Integration TREAT Steward integrates seamlessly into a range of existing hospital IT systems, providing an elegant solution to display all infection-relevant information for clinicians, specialists and management alike. Integration is typically facilitated through web services or HL7 standards. In current installations, TREAT Steward retrieves and understands information concerning: Patient background Medication and pharmacy Microbiology TREAT TREAT activation and single log on Early warning score and monitoring Patient administrative information Clinical chemistry Infection summary to EHR TREAT Steward Vital parameters

4 SUMMARY AND TREATMENT - Overview of infection-relevant data and decision support TREAT Steward s Summary and Treatment page gives an overview of all the information the system has collected as well as the treatment advice. In the example below, a patient from the community has a mix of different symptoms and findings that point in the direction of a urinary- or lower respiratory tract infection. TREAT Steward s Summary and Treatment page provides a printable one-page overview of all information relevant for determining the antimicrobial treatment, including advanced decision support.

5 CLINICAL VALUES WITH TREAT STEWARD - A powerful software tool for implementing antimicrobial stewardship in clinical practice Worklist - Binds all infection-relevant information together for the specialist The Worklist acts as a dashboard for the experts at the hospital, giving an overview of all patients receiving antimicrobial treatment, as well as those for whom antimicrobials should be considered. It provides an opportunity to review guideline compliance, usage of restricted antimicrobials and to monitor high-risk patients. The Worklist puts the hospital s stewardship team in full control. Inspection Tool - Supports reviewing of the temporal course of an infectious episode With TREAT Steward s Inspection Tool, the specialist team can review specific infectious episodes in detail. The episode history includes a complete overview of antimicrobial treatments, microbiology, vital parameters, biochemistry, hematology, blood gases and liver function indicators.? Risk Assessment - Makes an excellent classification of the septic- and non-septic patient TREAT Steward s risk assessment adds an additional layer to the information contained in the worklist. This functionality allows the specialist to identify which patients should be eligible for rapid diagnostic testing, and place extra focus on them to ensure expedited results. The risk assessment is based on a partial model of the systemic inflammatory response and is well-calibrated in predicting bacteremia and 30-day mortality. Infection Journal - Ensures and documents a high-quality patient examination TREAT Steward aids the clinician in writing patient records. Full integration with hospital IT systems means that only minimal data entry is required, and a structured, editable free text infection note is generated and sent back to the EHR. The burden of data entry is lightened while at the same time the quality of documentation is improved. Intelligent Advice - Supports the communication of local antimicrobial guidelines and policies TREAT Steward implements antimicrobial guidelines in an intelligent, rational and intuitive way. Through a calibration process, the decision support algorithm is fitted to local guidelines and preferences; in this way, the use of TREAT Steward helps to reinforce the guidelines and educate clinicians on current best practice.

6 MY PATIENTS - An educational review tool for tracking individual performance Ongoing training and knowledge sharing is one of the keys to prevent infections and prospectively optimize the use of antimicrobials. Through examination and review of My Patients, experienced infectious disease specialists have the opportunity to share their knowledge with clinicians that are less experienced. Using My Patients, a clinician can always follow the clinical results and performance for the exact patients they have treated. My Patients: a perfect place to educate doctors by reviewing the clinical outcome of their own patients.

7 CLINICAL VALUES WITH TREAT STEWARD - A powerful software tool for implementing antimicrobial stewardship in clinical practice Textual Guideline - Makes hospital guidelines available at point of care In combination with TREAT Steward s Intelligent Advice, the user has easy access to the most recent evidence-based knowledge about infections, microbiology and antimicrobial treatments. Dosing Assistant - Estimates the correct dose, frequency, timing and duration In addition to advice on diagnosis, pathogen distribution and treatment, the Dosing Assistant modifies the daily antimicrobial dose according to the patient s kidney- and liver function, weight and the focus of infection. The user-friendly interactive interface of TREAT Steward helps the clinician to identify the optimal treatment for each patient with respect to dose, frequency, timing and duration of treatment. Personalized Antibiogram - Personalizes the institutional antibiogram for each patient Using the institutional antibiogram as a starting point, TREAT Steward adjusts for whether a patient s infection is community- or hospital-acquired, and whether they have recently received antimicrobial treatment. This innovative approach also allows the likelihood of susceptibility to antimicrobials not included in standard testing to be estimated. My Patients - Supports reviewing and learning from the clinical outcome The nature of empirical antimicrobial treatment means that a patient will often be moved to another department or even discharged before microbiological results are available. At this stage, any opportunity for follow-up by the same clinician is lost. TREAT Steward provides a functionality called My Patients, allowing the individual clinician to follow up on the clinical performance of their choice of empirical therapy and whether or not it covered the identified microorganism(s). Reporting Tool - Provides simple access to measurements of clinical performance One of the true benefits of having coded clinical information is that it can be linked to the vast knowledge within the domain of evidence-based medicine and be used for statistical- and research purposes. TREAT Steward generates measures and statistics of overall clinical performance, antimicrobial consumption and guideline compliance, supplying department managers and hospital administrators with valuable input to their decision making.

8 DECISION SUPPORT - Introducing an intelligent antimicrobial guideline One of the key elements in TREAT Steward is the ability to use structured health care data to provide clinical decision support. TREAT Steward supports the physician in making the right decisions by helping the user to answer the following questions: - Is there a bacterial infection? - How severe is the infection? - What is the most likely site of infection? - Which pathogen(s) are responsible? - What are the benefits and costs of potential antimicrobial regimes? TREAT Steward s decision support modules utilize Causal Probabilistic Network (CPN) technology in the form of a comprehensive network of more than 7,000 nodes containing evidence-based knowledge gained from hundreds of studies. The cost-benefit analysis performed by TREAT Steward balances the costs of antimicrobial treatment with the benefits of the treatment. All costs are updated during the calibration process to fit local preferences and the hospital s antimicrobial policy. Even though clinical decision support systems have great potential, it is important to remember that they generate suggestions clinicians make decisions. Causal Probabilistic Network Cost benefit Analysis Drug costs Side effects Ecological costs Survival benefit Bed day benefit Personalized Decision Support

9 COMPREHENSIVE GUIDANCE - Personalized antibiogram and dosage adjustment Personalized Antibiogram Patient-specific antibiograms serve as a better starting point for the choice of empirical antimicrobial therapy than the institutional antibiogram. TREAT Steward adjusts the probability of susceptibility for each drug-bug combination to account for the place of acquisition (hospital- or community-acquired infection), recent previous antimicrobial therapy, and drug bioavailability (in vivo modification). When microbiological results become available, the antibiogram is adjusted to account for the results of the antimicrobial susceptibility testing including all the drugs that were not tested. Dosing Assistant The dosage module adjusts the standard antimicrobial ordination in relation to the patient s kidney and liver function, weight, and the suspected or confirmed site of infection. The dosage module integrates seamlessly with the hospital s pharmacy system.

10 TREATMENT QUALITY - TREAT Steward improves coverage while reducing consumption of broad spectrum antimicrobials 29% TREAT Steward minimizes the use of broad spectrum antimicrobials Clinicians TREAT Steward 22% 22% 16% Ecological index 12% 10% No treatment 0 2% 5% Nitrofurantoin 0 10% 12% Quinolones 200 Cephalosporines % 7%7% Pip-tazo 500 4% Aminoglycosides 0 8% Macrolides 100 3% 1% Metromidazoles 100 2% 0% Carbapenems 900 6% Other 200 Penicillins 25 9% 3% [Beilinson, 2015] TREAT Steward has been tested in 8 clinical trials involving more than 7,500 patients. Results show that clinicians supported by TREAT Steward s guidance can increase the percentage of covering empirical antimicrobial treatments by 15% compared to clinicians without access to TREAT Steward. Furthermore, the guidance can reduce the duration of hospital stay and reduce the use of broad spectrum antimicrobials by approximately 33%. Study type Beilinson Hospital, IL Clinical use Ref [1] Increased coverage 18% Ecological savings 29% 24% Beilinson Hospital, IL Retrospective Hvidovre Hospital, DK Prospective Sygehus Lillebaelt, DK Retrospective [2] [3] [4] 17% 17% 8% 38% 47% 32% 15% 61% Sygehus Lillebaelt, DK Retrospective NP 10% 36% Hvidovre Hospital, DK Retrospective [5] 20% -3% DE, I, IL Prospective, C-RCT [6] 12% 44% DE, I, IL Prospective observational [6] 13% 60% Average 15% 35% Covering empirical treatment Increased coverage by TREAT Steward Not covering treatment *IT = Italy, IL = Israel, DE = Germany, DK = Denmark

11 ECONOMIC BENEFITS OF ANTIMICROBIAL STEWARDSHIP - Saving lives, cutting costs and reducing the spread of resistance At a hospital covering a population of 400,000, TREAT Steward is expected to save 70 lives every year. It can be expected that TREAT Steward will help provide covering empirical antimicrobial treatment for an additional 840 patients per year, saving 1,680 bed-days. At a price of 400 per bed-day for an infection patient, this amounts to 672,000 in yearly savings. 400,000 Population 1.4% 15% 5,600 Patients hospitalized annually under suspicion of moderate to severe infection 840 Additional patients will receive covering empirical treatment 2.0 EUR % 672,000 1,680 bed-days saved annually 70 1/3 Additional patients will survive annually Reduction in the use of broad spectrum antimicrobials

12 Treat Systems is a dynamic Danish company focused on development and implementation of healthcare IT solutions, primarily for the diagnose and management of patients with infections. We use our extensive know-how in the areas of healthcare informatics and data mining technologies to deliver a family of products; supporting diagnostic- and antimicrobial stewardship in the clinical- and laboratory settings. TM TREAT Stewardi : Is your fully integrated, comprehensive stewardship tool binds all stewardship functionality together Reduces the use of broad spectrum antimicrobials by 30-50% preserving the effectiveness for future generations Increases the rate of covering empirical antimicrobial therapy... saving bed-days and lives AVAILABLE PRODUCTS Risk assessment Worklist Inspection tool Reporting tool Intelligent Advice My patient Infection Journal Dosing Assistant Personalized Antibiogram Textual Guidelines TREAT Steward advanced TREAT Steward plus TREAT Lite TREAT Lab TREAT Service X X X X X X X X X X X X X X X X X X Modules for use in the clinical setting Modules for use in the laboratory (+45) info@treatsystems.com Hasserisvej 125, 9000 Aalborg (+45) info@treatsystems.com Hasserisvej 125, 9000 Aalborg [1] Ward et al. (2017) Implementation of antimicrobial stewardship using an IT-based decision support system. European Congress of Clinical Microbiology and Infectious Diseases. Vienna, [2] Andreassen et al. (2017) A retrospective study of the performance of decision support for empirical antibiotic therapy. European Congress of Clinical Microbiology and Infectious Diseases. Vienna, [3] Arboe et al. (2014). Evaluation of the decision support system for antimicrobial treatment, TREAT, in an acute medical ward of a university hospital. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases, 29, ,[4] Østergaard et al. (2013). Retrospective cohort study evaluating a computerised decision support system (TREAT) for guidance of empirical antimicrobial therapy of bacteraemic episodes in an area with a low prevalence of resistant pathogens. European Congress of Clinical Microbiology and Infectious Diseases. Berlin, [5] Kofoed et al. (2009). Performance of the TREAT decision support system in an environment with a low prevalence of resistant pathogens. The Journal of Antimicrobial Chemotherapy, 63(2), , [6] Paul et al. (2006). Improving empirical antibiotic treatment using TREAT, a computerized decision support system: cluster randomized trial. Journal of Antimicrobial Chemotherapy, 58(6),

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